Assemblée législative de l'Ontario

PRE-BUDGET CONSULTATION

MINISTRY OF HEALTH

ONTARIO PUBLIC HEALTH ASSOCIATION

TERRY HOWES

AFTERNOON SITTING

HALT INCREASING TAXES

ONTARIO HOSPITAL ASSOCIATION

INCOME MAINTENANCE FOR THE HANDICAPPED CO-ORDINATING GROUP

PROVINCIAL COALITION ON SPECIAL SERVICES AT HOME

ONTARIO FEDERATION OF STUDENTS

ONTARIO COALITION AGAINST POVERTY

PERSONS UNITED FOR SELF-HELP IN ONTARIO

CONTENTS

Thursday 24 January 1991

Pre-budget consultation

Ministry of Health

Ontario Public Health Association

Terry Howes

Afternoon sitting

Halt Increasing Taxes

Ontario Hospital Association

Income Maintenance for the Handicapped Co-ordinating Group

Provincial Coalition on Special Services at Home

Ontario Federation of Students

Ontario Coalition Against Poverty

Persons United for Self-help in Ontario

Adjournment

STANDING COMMITTEE ON FINANCE AND ECONOMIC AFFAIRS

Chair: Wiseman, Jim (Durham West NDP)

Vice-Chair: Hansen, Ron (Lincoln NDP)

Christopherson, David (Hamilton Centre NDP)

Jamison, Norm (Norfolk NDP)

Kwinter, Monte (Wilson Heights L)

Phillips, Gerry (Scarborough-Agincourt L)

Sterling, Norman W. (Carleton PC)

Stockwell, Chris (Etobicoke West PC)

Sullivan, Barbara (Halton Centre L)

Sutherland, Kimble (Oxford NDP)

Ward, Brad (Brantford NDP)

Ward, Margery (Don Mills NDP)

Substitutions:

MacKinnon, Ellen (Lambton NDP) for Ms M. Ward

Wilson, Gary (Kingston and The Islands NDP) for Mr Hansen

Clerk: Decker, Todd

Staff:

Anderson, Anne, Research Officer, Legislative Research Service

Rampersad, David, Research Officer, Legislative Research Service

The committee met at 1004 in room 228.

PRE-BUDGET CONSULTATION

The Chair: I see a quorum. I would like to begin the committee hearings. I would like to welcome the Honourable Evelyn Gigantes, Minister of Health. I would like to let you begin.

MINISTRY OF HEALTH

Hon Mrs Gigantes: It is a pleasure to be here. I would like to introduce to committee members who have not met him, the deputy minister, Martin Barkin.

This is a new format for discussion of pre-budget matters, as I understand it. It is certainly a new format for me, so I hope the committee will excuse signs of incompetence, irrelevance and so on. I intend to try to make a very brief introductory outline that will indicate to you the approach that our government is taking to questions affecting the health of Ontarians and then ask Dr Barkin to lay out some of the more explicit kinds of considerations that provide the policy framework for your consideration. Then we are prepared, of course, to answer whatever questions you may have explicitly around matters of the financing of our programs.

I would like to begin by indicating that the approach that I, as Minister of Health, have taken since being sworn in to this position in October has been one to try to think of how we can best improve the health of Ontarians.

As you well understand, the development of policy and practice programs within the Ministry of Health has been largely associated with the public health insurance that we have providing hospital insurance and physicians' services insurance, so the development of policy, apart from providing public health insurance for those two items, has been slow.

Nevertheless, over the last few years there has been a lot of work done and I would like to acknowledge before this committee the work done by both Conservative and Liberal governments before the formation of this government in attempting to develop a broad policy framework for the betterment of the health of the Ontario population. It is a slow process, but much progress has been made and we will speak to some of those items as we go this morning. I am sure you will want to ask questions about how that relates to our financial planning.

In very general terms, what we know that has come out of the work that has gone on in the discussion of public health policy and the health of Ontarians has been an acknowledgement that the delivery of health services is only one part of what has a large influence on the overall health of the Ontario population.

We have come to recognize, through the planning of health policy, that in fact social and economic factors are intimately, closely and irrevocably linked to the overall health of this population, as with other populations historically and geographically in our universe. We have not traditionally paid very much attention to that fact in the way we have worked towards trying to better the health of the Ontario population, or the Canadian population, though in fact it was Canadian sources which first began to identify that very important element in health planning.

What that means, of course, is a great many things. It means that somebody who is responsible for working towards the betterment of the health of Ontarians has to pay very close attention to the social and economic policies that are developed within the government serving that population. We have also learned that the environment -- the work environment, the life environment, the environment, for example, in terms of the safety of highways -- is a very important influence on the health of a population. We have learned that people's life habits have a very profound influence on their health and, consequently, the overall health of the population. Fourth, if we are to identify the major factors influencing the health of the population, we of course look to the delivery of health services.

You will want to talk to us about all those elements. I suspect you will want to spend most of your time on the fourth, but I wish, just in the beginning, to indicate to the committee that in terms of this government's approach to health planning for the Ontario population, we are trying to make those policy decisions and develop those programs which will include the important contribution of all four elements to the overall health of the population.

On top of that, I can say that this ministry which I am representing before you today on behalf of the government is one which is currently spending a very significant portion of the revenues available for government in Ontario. That is also true in other provinces. As Dr Barkin will mention, in comparative terms, Ontario is perhaps focusing overly on the delivery of health services when we think of the other elements which I have just enumerated which contribute so significantly to the overall health of the population.

With that brief outline, I would like to pass over to Dr Barkin to speak a little more precisely about the matters which you will probably want to discuss in more detail.

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Dr Barkin: To the recollection of me and my staff, although this committee has been in operation for about three or so years, this is the first time the Ministry of Health has actually been before the committee.

In order to provide the committee with the maximum opportunity to ask questions and engage in dialogue, I pre-circulated remarks that I had prepared. I have no intention of delivering all of the remarks, but only to highlight them and not consume too much of the time of the committee, and perhaps focus on a few areas. I hope they are areas that are of interest to the committee, but if they are not, the committee can focus its attention on the areas of interest to it. I have with me some staff; if I cannot answer the question, I hope they will be able to provide you with the answers. If neither of us can at this moment, we will be sure to get the answer to you in a timely way.

The minister introduced a commentary about the determinants of health in our society, of which the health care system is the fourth determinant but one which for Canadians traditionally has been of very high value.

It is no great secret to anyone that as we have the two conflicting problems before us, our need and desire to maintain full accessibility to every appropriate health care service that we can to all of our citizens, the other side of that coin is to do so within an affordable and manageable framework, because we cannot sustain the health of our society without having those two in balance.

One of the difficulties traditionally that ministries of health have had in this country is that they have had as their roots an insurance background. We really never have been managers of a health system. We have been insurers and funders of health services generally left to others to organize and manage and deliver. So as we finally have had the fiscal pressures come into balance with the service pressures, we have now had to look at and reconfigure that paradigm and see to what degree it needs to be restructured, while we remain true to the principles of universality, accessibility and comprehensiveness of health care services.

Virtually every jurisdiction in Canada has put together some form of advisory body to the province, whether it is called a Premier's council or a royal commission or a named commission. Everyone is looking almost everywhere in the world to see where the appropriate organizational solutions to managing that balance between full health care services available to everyone within an affordable framework can be found.

Rather than go through everything that is the commentary that I have, therefore I am going to just concentrate on three areas.

One of the areas that comes up as a possible solution -- and rather than project the slides up, perhaps I can circulate these to the members and two or three people in the gallery -- is the notion of a free market system in health. We hear this quite frequently, "All things can be corrected by allowing market forces to prevail."

In order to see how the free market system works in health care, we ought to look south of the border, since it is the home of the free market system in health care and probably the last jurisdiction in the world to rely on that. What we see is both the highest gross national product devoted to health as well as the highest per capita spending in the world of any country; 40% higher per person in fact than Canada, according to the Organization for Economic Co-operation and Development. One of the most remarkable comments I would make is that health care in the United States, in and of itself, is the fifth-largest economy in the world, larger than the economies of all of the other countries of the world but five.

Yet in the face of that kind of expenditure, it has at least 30 million uncovered citizens, 37 million partly covered. Its health indicators, overall, are falling. Its neonatal mortality, birth weight, maternal mortality, life expectancy from a variety of diseases is now falling, not rising, as it is in almost every other western country. It now rates in the World Health Organization lexicon as 19th in overall quality of life, and notwithstanding its huge expenditure, its own polls show that its consumers and providers together are the least content of those in any country where it has been polled.

I should point out that the United States has more user fees for the vast gamut of its health services than any other country as well, and that its health care costs are now affecting its competitiveness, its ability to generate wealth, as its major manufacturers attest, and has become so heavily regulated and intrusive that one observer told me that the health care financing administration in the United States passes a new regulation every seven hours.

It is a remarkable change in the way health care has been delivered in that country since 1983, and in the recently passed Congressional Omnibus Budget and Reconciliation, 1990, an act which had frozen physician fees since 1983 under medicare, they were now recommending 10% rollbacks and they now were producing even further draconian measures in the management of health care expenditures there.

The one final thing I would say in terms of efficiency of the free market system as opposed to the government system is that in testimony before Congress it has been estimated that if the United States had the government-run insurance-type system that is now present in Canada, the United States would be saving $50 billion a year, that is non-health-care dollars, in the paperwork involved to sustain its system. So if anyone still wants to recommend a free market system or portions of the free market system as a solution, they would have to deal with those obvious failures when that works.

If we switch over and have a look at the Canadian system in the constellation of world events, we are not exactly doing better than the rest of the world, although when we compare ourselves to the United States we do quite a bit better. We have in this country the highest per capita expenditure of any country with a national health system. We are now devoting $1 in $12 of the national economy to health care.

Notwithstanding that fact, that it is costly, it is also of value. We captured a lot of the values of the Canadian health care system in the Canada Health Act, but an external observer, an editor of the New England Journal of Medicine, looking from the outside into Canada, said that he had found another value that Canadians feel but do not articulate and that is the concept of equality before the health care system. He equated that to the American concept of equality before the justice system. The view is that no one ought to be able to buy himself a better brand of justice simply because he has more money. We have transposed that kind of value into the health care system, whereas they have not.

I do not pretend for one moment, and neither do the Americans, that the Americans have achieved their absolute ideal when it comes to justice, any more than we have achieved our absolute ideal when it comes to health, but it still remains an ideal and a goal and we work towards it. And we get closer to it all the time.

Within that value, our growth is exceeding inflation by more than two times, and it is encroaching on all kinds of other priorities that promote the health and wellbeing of Canadians -- affordable housing, welfare, education and research.

Up to now we have, however, maintained a reasonable balance between other priorities that promote health and health care. We have been doing something right, because Canada remains and Ontario as part of Canada remains in the top five of nations in the world in our health indicators, and we remain in the top five in the world as a nation in overall wellbeing.

Where do we see our biggest problems in health care? We certainly see problems in access to high-technology services. We certainly see problems in access to certain specialties in certain areas. We certainly see problems in access to beds. But the reasons given do not seem to stand up. We have trouble in access to beds, notwithstanding the fact that we have one third as many beds per capita open, funded and in service at this time, one third more than, say, the state of Minnesota, or Baden-Württemberg, Germany, depending on where you want to look. Our patients tend to stay in those beds one third longer than they do in almost any other jurisdiction even though we have a publicly funded home care system, which has a long way to go in and of itself, but is certainly better than what is available in the jurisdictions that use their beds less.

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We are told that the reason our health care system is rising in cost is because of our demography. That cannot be entirely true either. We have one of the youngest populations in the world. Countries with one third or half again as many over-65s and over-75s as we have are not having as much difficulty as we are and seem to be facing that kind of demography. In fact, the thing we have to worry about today is that when we reach their age mix -- and we will in the next 15 years -- if we continue to use the kinds of services and apply those the way we do now, we will exceed their expenditure by much more than the 25% or 30% that we do now.

We are told that the problem is the high cost of new technology, but I would have to tell you, as Deputy Minister of Health, I have not had any proposal for new technology put before me that did not also have with it a caveat that said if I put this new technology in place or if the ministry approves it, we definitely will save a lot of money in the health care system. You would think that the more technology we put in, sooner or later the Ministry of Health would be a revenue producer for the government, rather than a consumer. I apologize for the facetiousness of that comment.

We are told that one of the reasons it does not work is that it is run by the government. The governments are running health care systems all over the world. In fact, one of our problems may be that our system is not run by the government; it is an insurance-based system as opposed to those systems in Europe and in England, where the government takes a much greater hands-on position on that -- not intrinsically a Canadian value.

The real reason that we understand was the problem lies in our roots as an insurance agency rather than a health system manager. We are in fact, and have been until recently, an unmanaged system. Dr David Naylor, in appearing before the House of Commons committee on health and welfare, made that very clear in his testimony. The degree to which we have begun to start managing represents a very slow start and we have a great deal more to do in this area, but I could offer you a few examples and then a concluding comment and we could go to some direct questions and answers.

In the prepared comments that I was going to talk to, I could say that we really started a lot of our activities in the early 1980s, but in 1989 began to look at things in earnest. Some of the things that have happened since then were the passage of the Independent Health Facilities Act, 1989, which for the first time is a health services act that requires quality assurance and outcome review as a condition for continued licensure. We mandated utilization review in public hospitals and provided guidelines for those hospitals. In co-operation with the Premier's Council on Health Strategy, the Ontario health survey was launched in order to give us an indication of the health status of our population and to try to trigger expenditure to that as opposed to certain other factors.

We began the health insurance reregistration process in order to provide us with real information about what was going on. I am pleased to say that last Wednesday, we had for the first time a presentation from the Centre for Health Economics and Policy Analysis at McMaster demonstrating that even with the information that we can generate today, we can now begin to look at regional planning and reasonable allocation of available resources according to population needs, demography, gender mix and prevalence of disease, a facility we have never had up to now and one that is quite important.

Perhaps the single most important change, however, that has occurred in the last two years is a shift, I think, in the awareness of most of the major providers that working with the system to produce this evolution will be an important way to make it work. I am delighted at the responses we have certainly read, at least in the media and in some of my private conversations with, for example, the Ontario Medical Association and the Ontario Hospital Association, indicating that they now understand that to continue to have an affordable and manageable health system that is providing access to all of our citizens to the service that they need, we will have to work together within this framework of managing a health system as opposed simply to insuring it.

That concludes my opening comments, Mr Chair and members of the committee. There are some additional details in the handout. I would be pleased to assist the minister in answering any questions you might have.

Mr Phillips: I wanted to get on early because I missed a couple yesterday. Deputy or the minister, we are kind of looking ahead at the next fiscal year. Many of the things you talked about are kind of a longer-term direction. I just wondered if you could give us some help in terms of what we should be thinking about in terms of the health budget for next year, bearing in mind that I think two parts of the budget, if I am not mistaken, hospitals and doctors, represent close to 80% of the budget.

In the hospital sector, I know the nurses' contract expires at the end of March, on the first of our fiscal year. I believe the Premier has made some fairly significant commitments to the nurses. I think there are negotiated settlements with the rest of the staff in the 8% range. Again, if you look at the hospital budget, I think, in theory anyway, we are looking at some very substantial increases in what is the bulk of the hospital -- probably 75% of hospital expenditures are staff wages.

The second one is, I think around 32% or 33% of the budget is fees for physicians. The last fee increase was, I think, 1988. I believe that there was a commitment to binding arbitration for the doctors. I guess their biggest area is the drug benefit plan. I think that is another $700 million of the budget, with the report. I wonder if you could give us some help in terms of what we as a legislative committee should be thinking in terms of increases in budgets for the health ministry.

The other thing is community-based care, which is something I think we all are very much supportive of. I think that most people believe you have got to invest in that. You cannot just say we are going to have it and not have the resources there. How much should we be looking at next year in terms of community-based resources within the Ministry of Health budget? If I remember correctly, people say that psychiatric patients were deinstitutionalized in the 1970s without necessarily the community's support.

So those are my three questions, really. The bulk of the health budget is hospitals and doctors' fees. For both of those, it seems to me, there are some significant commitments made to the wages or the fees in those areas. What should we be planning on? For community-based care, what kind of investment should we begin making next fiscal year so that we have that community facility in place?

Hon Mrs Gigantes: Mr Chair, those are the questions. I would love to know the answers. At this stage, as you will understand, we are in the process of looking at our accounts, trying to figure out what negotiations with the doctors, with nurses, are going to mean and also, trying to figure out what kinds of moneys will be available for expanding community-based care.

As the deputy minister described it, the situation we face is one where much of the demand financially is for programs which have been open-ended, provided through hospitals by physicians and in which we provide the insurance payments. That being the case and that making up the bulk or a very large portion of the expenditure of the ministry, one tends to think of what is left over for building up the kind of community-based services we would like to see, many of them pseudo-medical, not necessarily delivered by doctors and certainly delivered in ways that we would tend to think of as non-traditional, new ways, and supporting the kinds of goals for policy planning that are associated with the determinants of good health that I spoke of earlier.

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That being the case, we know that we are going to have difficulty this coming year trying to shift the emphasis within the overall budget of the Ministry of Health from the traditional delivery system, which I will stress has in many cases not been good quality. I think that most people, for example, in Ontario would agree that we can provide better services to people who have chronic health problems than we do in the current delivery system, which does not provide a full range of services, does not provide services very frequently where people want them, which is at home or in residential settings rather than in highly institutional settings.

Turning the system to a new direction is a slow process, and it is a process in which one has to fuel the existing system financially so that it operates adequately to meet people's needs as best it can, while at the same time trying to develop new ways of meeting those needs. That is a difficult problem.

You have identified the exact nature of the problem and we will simply do the best we can, given the need for money in the existing system and the new contracts which will be worked out with nurses, with doctors, and look for resources to help build those kinds of services and use those kinds of service providers in the system so as to better meet the needs of the Ontario population. That does not really answer your question, but I do not think there is an easy answer to your question.

Mr Stockwell: That is the hard one.

Hon Mrs Gigantes: That is the hard one.

Mr Phillips: I am just saying this is 34% of the budget. We are presumably trying to help the province to operate well and the recommendations, if they have some value, will be your best estimate of what is going to be required to achieve your objectives. I realize the Treasurer then has the responsibility of saying whether that is deliverable or not.

Hon Mrs Gigantes: Yes.

Mr Phillips: I would like some help because I think you now know probably what, in ballpark, the hospitals may require and what the nurses may require. Those are the two large components of the budget. Can you just give us some indication of that?

Hon Mrs Gigantes: And the doctors. Maybe you would like to make some comment, Martin. I do not know how specific we can be, because these are, at this stage, things that we do not control, though we can hope to influence.

Dr Barkin: To the degree that I have any feedback from the Treasurer, I will try to answer as much of the question as I have at my disposal. We started out with a couple of principles. You asked a number of questions and I have sort of written them down. If I happen to have missed one, please remind me.

In that constellation of questions you asked about the difference between the non-institutional-based services and the institutional-based services and we have started out in our own budgetary planning process with the basic premise that the rate of growth of non-institutional-based services -- community services, home care -- will always be greater than the rate of growth of the institutional-based services. So that was the first principle with which we approached it inside the ministry and we will still want to hold to that.

The second general principle we started with is that there is a rate at which any complex system can adjust to change and there is a rate, if one exceeds the stimulus to adjustment to change, where that adjustment becomes quite difficult and sometimes will be disruptive. If we agree that there needs to be some change in the way services are delivered, then there needs to be, from a funding perspective -- because at the moment that is the only lever that we have until we are much better at a co-operative management paradigm -- then funding cannot possibly respond to everything that everyone wants to maintain the status quo, since the status quo clearly has to change. Our most difficult decision will be to what degree funding, as an incentive, as we heard from the Premier's Council on Health Strategy last year, can be used to shift from institutional to non-institutional options and to deal with the whole pattern of delivery of services in a way that the system is capable of responding to.

That will take a lot of dialogue, but we are certainly aware of the pressures that you described, as you know from the Ontario Hospital Association's news release. They presented their figures to the Treasurer. I was present at that meeting and the Treasurer commented that, based on the way the hospitals were now operating and delivering services, he felt that they had given a fair analysis of that. The question that we did not answer and have not answered as yet is, to what degree and at what rate can hospitals continue the rate at which they are modifying their pattern of service delivery? And they are doing that now. Lengths of stay in Ontario in the last couple of years are starting to come down. That is not to say that they are not under some degree of pressure. In a lot of areas they are. That is part of a judgement that the government will have to make as we present it with the various dollar configurations that are before us and the kinds of pressures that each dollar configuration will put into the system and the capacity of the system to respond to that pressure and still maintain the appropriate array of accessible services.

Mr Phillips: I just want to make sure I understood that we should be looking at a greater percentage increase in dealing with health. That is the kind of indicator or direction. The only comment I make is that some of the hospital spending is through arbitrative settlements which are in some respect out of their control, as I guess with binding arbitration. The physicians' fees now might be somewhat out of the control of the ministry.

Dr Barkin: Right. All right. I will not comment; that is fine.

Mr Phillips: I have one comment.

The Chair: I really must move along. I have six more questioners. Mrs Sullivan is next please.

Mrs Sullivan: My questions are a direct follow-up to those asked by Mr Phillips. I want to really have you speak a bit more about that transition phase between heavy emphasis on institutionalization and so on. Moving on to deinstitutionalization and where the incentive funding, the stimulation for change that you talk about, has to change, whether in fact, over a short or interim period of time, you want to see a specific increase in your minister's budget for transition purposes.

I would also like to ask you how you see your ministry in terms of provincial management and the way we see the budget set up now, your ministry's rationalizing that kind of budget stream, say, with Community and Social Services on the long-term care program. Do you see perhaps a reduction in some of the Comsoc budget with a shift into a new mechanism? Where do you see increased emphasis there and do you see, once again, a short-term shot that is necessary or is this something that will happen within the context of a third of the provincial budget being dedicated to the Ministry of Health?

I would also be interested in hearing your views on the additions of co-payments into the health care system. I would also be interested on your views on the impact of a change in funding systems of, for instance, case load funding systems versus fee for service; once again, the impact on your bottom line.

The Chair: Well, that should take care of the rest of the morning.

Hon Mrs Gigantes: Perhaps I could speak to one element of the questions that the member has asked. I think it is a very important element and I think it links with other questions that you framed together, and that is the question of incentives and how much incentive one provides.

Indeed, within the institutional framework of our budget, we will be looking at devoting a larger portion of the funding to incentives. That is an aim in our budget planning. Martin, you might like to pick up on other things.

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Dr Barkin: Yes. I hope I managed to capture all the questions and I will try to address them all to allow some further time for questions. The question had to do with the shift primarily from the institutional sector to the non-institutional sector. On the long-term care principles, part of their implementation will be facilitated by the fact that we now have a single assistant deputy minister who stands astride community health and community social services. We are now beginning to integrate the budgets of the two ministries for that particular purpose.

We can separate the stream for public accounts certainly and to remain accountable to the Legislature, but we now look at this as a pool of funds between the two ministries for optimal spending. Perhaps I can help by just reviewing the principles around which we based the long-term care reform because they are quite important.

The first principle is that in order for any long-term care system to function, the access to that care has to be managed. When we talk about managing a system, people kind of think that sometimes we are talking about overmanaging a system or overregulating a system. In this case we are talking about management of access to the system so that people who need the service have a single place to go, can be appropriately assessed and then move to the service or constellation of services that they need.

In the long-term care access, that pivotal point was called a service access organization. It is a multidisciplinary based team that receives the patient and has some form of overseeing public governance to ensure that it remains accountable to the local community in which it resides. Once you have accepted a single point of access and the ability to place patients in the services they need, the way the services they need are managed also has to change.

The way it changes is to fund those services not on the basis -- I am going to your second question -- of a per diem rate or a flat rate, but on the basis of the level of service they provide. So whether the patient is in an extended-care facility or is in a home care program, level-of-care funding then becomes the second major ingredient to make that system work. There are a lot of other pieces around that.

In looking at the management of the system and the number of beds required to deliver that aspect of the system, we have never separated that from the total number of beds in the system because there is a continuum, from acute care to chronic care to extended care to home care, and different people at different times require one of those services. The position we are in now is that as management of access to the latter half of that system has failed to provide a managed access to the degree that we would like, the rest of the system upstream from it, starting with the acute care side, begins to dam up.

We will see anywhere from 15% to 18% in some areas of our acute beds occupied by patients who should start moving into more appropriate services that are downstream. The first response is, "We are short of acute beds, so build those acute beds." At a couple of hundred thousand dollars a bed a year to build and a couple of hundred thousand dollars a year to operate, it is a lot more sensible to build what the patient really needs as opposed to what he does not need that costs three times as much. So the whole cost equation shifts as well.

Mrs Sullivan: Just on that, do we have adequate acute care beds now, given a shift? In fact, do we have too many acute care beds now?

Dr Barkin: If the shift is achieved, we probably are overbedded on the acute care side, as the United States found itself some four or five years ago. As you may know, about 40% of the beds in the United States are now empty and unoccupied. They have gone from their 95% or 98% occupancy in 1982-83 to a 60% or 63% occupancy, because theirs is a for-profit marketplace. Of course, the difference between them and us is that their hospitals are facing bankruptcy. Many of them are going bankrupt. The level of private-sector hospital corporations going into receivership is rising.

I am not sure I covered all your questions. I did not get a chance to write them down.

Mr Kwinter: I would like to make some observations and then I want to present a question. Frank Miller was the Minister of Health in the 1970s. When I was the Minister of Industry, Trade and Technology he happened to report to me. In a conversation I had with him one time, I asked him, when he decided the health care costs were out of control and advocated closing some hospitals, what his budget was. He said it was $2.7 billion. At that time he thought it was out of control. He had to back down from closing the hospitals because of public pressure. So that is one factor in the equation. We have gone from $2.7 billion in the 1970s to $15 billion now.

In another situation, it is my understanding we have a population of just over nine million. We have over 20 million OHIP accounts, which indicates that somehow or other there is something screwy for that to happen. I understand the new health card is supposed to address that.

We have another situation where we have an open- ended health care demand system. The previous government tried to cap expenditures of hospitals, which would have meant that, let's say in November, if you run out of money and patients come to the emergency, you have to turn them away because you have not got any money. That is unacceptable, so there are overruns. Yet the decision was that we have to put these things under control.

Another anomaly is that we have a situation where you have stated yourself that we have the highest per capita expenditure in any of the national health care systems in the world, notwithstanding the fact that we have got the youngest population. Because of that, we should have the lowest expenditure, given the fact that as you age you have more demands on the health care system.

After making all those observations, it is obvious that the system is not being managed. I am not saying that in a negative way. I am just saying that there is no control over it because it is not a control system; it is a demand system. If someone presents himself to the hospital, you do not determine whether you have to see him; you have to see him.

My question is that other jurisdictions are looking at putting in some controls, Quebec particularly, where they have announced they are looking at a user fee. Are you contemplating recommending to the government any kind of a user fee or any kind of constraint that will try to get the system under control?

Dr Barkin: I presume that question is addressed to me.

Hon Mrs Gigantes: That is to you. I might make a comment after you answer.

Mr Stockwell: I might make it before you answer.

Dr Barkin: What we will present to the government is all of the evidence around the various management levers that have been tried in a lot of jurisdictions. We have lots of case study analysis of the impact of so-called user fees in the system. There are different forms of user fees. It is very hard to come to grips with it because it carries a lot of reactions. Let me deal first with user fee at the primary care level, with the notion that the system is manageable by a user fee at the primary care level.

We have about three scientific, if you like, studies that we can go on that are fairly extensive, two in the United States, one headed up by the Rand Corp, and the historical study in the province of Saskatchewan from 1968-72, where there was at that time a nominal user fee put in place for-primary care.

The impact of putting in a user fee for primary care is supposed to cover two functions: One, it is a new source of money in a system that cannot fund itself from other ways; two, the theoretical advantage of those who support it is that the user fee will deter people from inappropriately using the system. That is not in fact why Quebec is putting in its user fee. The media inappropriately reports it. I have read the Quebec report in its entirety and I now understand what they are after. This is not a user fee.

It turns out that neither is correct. The first thing that is not correct is a user fee as a significant way of raising funds for the system at the level of primary care. We have about 100 million OHIP transactions a year. About 20 million or 25 million of those would have fallen into the category Saskatchewan applied the user fee to. If you thought of a $3 fee or a $5 fee, that would be about enough to keep the ministry running for two days. So as a significant source of funds, it really is not, and one ought not to think of it in that way.

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Is it a deterrent of inappropriate care? Quite the reverse. What in fact happens when there is a user fee is that as you saw in Saskatchewan, the total number of services which are consumed in the system do not change one iota. The rate of rise of physician visits in Saskatchewan from 1968-72 continued without a hiccup to be exactly the same as the rate of rise in every other jurisdiction that did not have a user fee. What did happen was that the concentration of services moved to the middle-aged and middle class and away from the young, the old and the poor, the very population group you would want to reach.

In almost every jurisdiction where it has been studied and tried, a user fee is neither a significant way of raising funds for the system or a significant way of ensuring more intelligent use of the system. When you really think about it, what is there in the act of paying $5 that makes you, the ordinary citizen, a smarter self-diagnostician than you would have been had you not paid the $5?

However, we move from user fees for primary care to co-payments for other services in the health care system, because we have, as you know, in the Canada Health Act described universality and accessibility in terms of essential health care services and have clearly defined those and restricted those, but there are other things in our society that contribute to one's health and wellbeing that would not be defined as an essential health care service. That is a decision governments make, as to what degree they will provide those services and to what degree they will subsidize those services and patients will participate in them, and different governments have different views on that.

Finally, does anything help educate consumers? I think that is the gist of your question, and the answer is yes. Education itself helps educate consumers. Knowledge by itself helps educate consumers. In the Ontario drug benefit plan, a significant change was made about four or five years ago. We said that the dispensing pharmacist needed to put right on the bottle not only the prescription, but what the cost of the drug was and what the dispensing fee was. Simply giving the consumer knowledge was itself a very significant factor in having patients ask questions and sometimes take some very specific action as a result of the questions they asked.

I cannot resist, Mr Kwinter, however, in dealing with your other comment on the 20 million OHIP registrants. I had that exchange in front of the public accounts committee too, since, as you will recall, the Provincial Auditor pointed that out.

There were two databases in the existing OHIP system at the time the 20 million came up. One was the active database recognizing the insured population; another one was an archival database that recognized any previous number the same individual might have had, or someone who had been deceased or left the province or got a new number. Because people move around, forget their number and get new numbers, we had nine million on the active database list, but so no one could lose his insuring history we kept the archive of any previous number that he might have had. That was the basis of there being 20 million or 25 million. Even in the new reregistered system we will reconcile the person's new number with any previous number or numbers he may have had in the past.

Mr Kwinter: If I can just follow up, the purpose of my question really is that I wanted to get an affirmation from the minister or the deputy that you were not contemplating a user fee. I am not advocating a user fee.

Dr Barkin: Oh, all right.

Mr Kwinter: Given this situation, given the fact that, as I say, other jurisdictions are looking at it, I just wanted to confirm that you were not.

Hon Mrs Gigantes: We are not considering a user fee.

Mr Kwinter: Okay, that is fine. Now what I want to know is that if you are not going that route. what is your strategy to deal with some of the concerns I have identified? That is shut out to you, and I agree with that, but okay, now what do you do?

Hon Mrs Gigantes: The concerns you are raising are concerns of overall management in a relatively complex system. That system is one which government has begun to analyse and try to direct in a way which does not shake up the delivery of service while redirection is being established. I do not think there is one overall answer to the question in specific areas. There are specific kinds of responses.

For example, when your colleague asked the question about whether there would be a greater allocation of money that would be used for incentives to hospitals, the answer is yes. When we get to other questions that relate, for example, to the proportion of services that are going to be provided in community-based service forums, then we are going to see those grow at a faster rate than the rate of growth of institutional services.

When we get to trying to provide a system which will adequately meet the needs of people with chronic health problems, the system known as the long-term care project, the deputy has described some of the ways in which we will try to influence the redirection of service delivery by purchasing and providing funding for the services that are adequate and appropriate for the individual, as opposed to placing an individual in an institution because there happens to be a bed in that institution and no other adequate provision of service as an alternative.

There are various responses in various parts of the system that we have to look at. The user fee concept, as the deputy described it to you, has generally been one which has been advanced for use in the primary health delivery system and in that system we are not contemplating using it.

Mrs Sullivan: Perhaps I can just follow that with a supplementary on co-payments.

The Chair: Excuse me, Mrs Sullivan. You are out of order, please.

Mrs Sullivan: I know, but I wanted a question.

The Chair: I would like to move along to Mr Stockwell now, please.

Mr Stockwell: I guess quite a few of my questions actually were asked by Mr Kwinter. I thought they were very good questions actually and well timed. The difficulty I am having is that I think we have a monster on our hands and it is just totally out of control. I think it takes dramatic action to bring it under control. I think probably most people would agree with that -- except maybe some people in this room -- in this province.

I look at the transfer payments over the last five or six years and they are eating up nearly 50% of the transfer payment budget, and it is growing. In fact, in some cases some people are suggesting that it is going to be almost 100% of your transfer payment budget by the end of the century, and it is scary. Can we afford the system as it sits today? I think everyone would agree that the answer seems to be no. It cannot fund itself.

The question now is on your new directions. I hear talk from you and the deputy minister about new directions and where we are heading. How long until we determine that they do not work too? I think that is the question that is on my mind and I think on a lot of constituents' minds in the province. You know, "Let's go through this process," and it seems like we have been going through a new process every year for the past five or six years, and there are a new idea, new directions and all these lovely words when none of them work.

It seems to get farther and farther out of control and here we have the new government coming forward, using a lot of the same words the old government used and saying, "Trust us." Fine. If we trust you, how long before we determine that this was in fact a colossal flop. We are going to have to drive a stake through the heart of this system, because obviously it is just totally out of control, and relook at the whole process. How long are you going to give your new directions, your new programs, your new processes and then decide whether they are a success or a failure?

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Hon Mrs Gigantes: I am certainly not contemplating, nor is this government contemplating driving a stake through the heart of the health delivery system, for sure. I think that the measures that you and the people of Ontario will put to the success of what this government, as the previous government, is attempting to do in redirecting the delivery of health care services will come slowly and incrementally.

I do not think we can expect dramatic change, and I think dramatic change in this system would not be an appropriate response. I do not think it would be meeting the first test of the system, which is to deliver service that will meet the health needs of Ontarians who need health services. We cannot tear up that system and start from scratch. In the meantime, people need help and they will continue to get help through our health care delivery system.

We will look for change and we will build for change and we will demand change and we will urge change and we will provide incentives for change and we will provide disincentives for the status quo in certain areas. We will use a combination of measures, to the best of our ability, to try to achieve those changes in direction which we have spoken of. Also, we will ask members of this Legislature and members of the public for their ideas about how we can improve what we are doing in searching for change.

It is quite fascinating to me in this new role to receive -- I have not asked for a count -- myriad letters and I know there are myriad phone calls too that come both to the ministry and to my office, lots of suggestions from people about how to improve the system. I think there is an active realization on the part of the public and certainly on the part of a lot of service providers that change is needed. A lot of the ideas that come to us in written or verbal form in fact reinforce some of the methods we are trying to use to effect change. But it is going to be slow change. I think fast change is not healthy.

Mr Stockwell: Just to follow up, I can buy into your slow change, I can buy into your incremental change and the fact that it is going to move slowly. I am not suggesting for a moment that that may not be the best route to go. What I would like to know is what your goals are. How are we going to measure your success? Frankly, we had better start measuring the success of this system before -- I think it has a life of its own already, but before the life takes over our lives. How do we measure your success in two or three years? Tell me what your goals are. If you have not achieved them, we can come to this committee and say: "Gee, you didn't achieve your goals. What are your new ideas?"

Hon Mrs Gigantes: Overall, I think that is not a hard thing to do, because within five and l0 years in a given population you can certainly see what happens to the life expectancy of the overall population and the quality of life measured in terms of health measures for the overall population, and you can do that for significant groups in the population which have had inadequate support for achieving health. I think of groups, for example, like the native population in Ontario, which have unacceptable standards of life expectancy and quality of life. We will be able to measure that change. It does take time obviously, but those things are measurable. In other areas I would like to leave it to the deputy to speak about some of the measures that are being set in place, but there again I think that members of this Legislature and the public will in the future be able to look at standards and measures and ask, "How well is this delivery system doing?"

Mr Phillips: That is, first of all, life expectancy.

Hon Mrs Gigantes: I think it is a very important overall test.

Mr Stockwell: Mine were financial by nature. Mine were the questions regarding your financing, the costs.

Hon Mrs Gigantes: Money is one of the easiest things to count. You can count how much gets spent. Then you will have to balance the effectiveness of the spending and whether we are achieving better quality in the system for what we spend. Those two things should not be impossible for you.

Mr Sutherland: Just an observation: Maybe the problem is just that we are an unhealthy population to begin with, I do not know.

My other comment was in terms of developing a provincial management system for this. I have talked to many people in my constituency about health care and hospitals and things like that. There is always the concern that a provincial health system is not going to meet community needs. In some cases they may not be able to get all their services within their community. That is not so much a large problem in my riding, where you are only an hour away from good health care no matter where you live. In some of the other ridings that may be a concern.

I am wondering if you could comment on that for those people out there who are very concerned about getting health care in their own community. If we are moving to a provincial management system, does that mean some people may have to go farther for certain kinds of health care, and does it mean that in some communities not all areas are going to be able to be provided?

Hon Mrs Gigantes: I would hope it would mean that people would not have to go as far for most health care services. I would hope that as we build up community- based services people would not have to go, for example, away from their homes in many cases and into institutions to get the kind of service they need.

Obviously, at the very technical and highly specialized level of service, the consolidation of service delivery is important. It is important, I think, in terms of quality as well as in financial terms. Management of the health system helps us to try and ensure that that is done on a reasonable and equitable basis. Again, the deputy might like to speak more about this, but there has been some improvement in the way people get access, for example, to coronary surgery, if required, in Ontario.

That is a result of hard work, both on the part of providers and on the part of people working in the Ministry of Health to try and make sure that happened. And it has happened. I think there is a better system now of delivery of that service, highly specialized service, than there was two or three years ago. You will probably find evidence in communities around Ontario that that is the case. That can happen in a number of other areas; there is still a lot of work to be done.

Mr G. Wilson: I guess my questions have largely been answered by the discussion to this point, although I did want to make one observation, especially in relation to Dr Barkin's response to the question of user fees. I am pleased to see we are learning from experience, as outlined by your points about why it does not work. I was reminded of the present dismaying situation in the Gulf, that there we do not seem to learn that war is not the way to settle problems. Of course, that also raises the question of how we are able to afford the huge costs that are associated with that, yet here we are very concerned about the cost of health care.

Of course, it is a valid concern. I guess my question arose, though, with the question of education. Dr Barkin also referred to that, education being an element of health care in the sense that we have to encourage more healthful living practices. I was wondering about the education of the larger population and what role the Ministry of Health is taking in that, both with regard to the population at large but also to the providers of health care in the system at all levels, not only doctors and nurses but right down to the orderlies in the hospitals, as well as the transition we are hoping to make into different kinds of health care. What is in place there and what is the response?

Dr Barkin: The minister has asked me to answer your question. There are certain things we are doing and certain things we ought to be doing more of, and we will certainly be exploring that as we evolve the priorities of the budget.

Let me first tell you some of the things we are doing. On the population side, we have had two goals, first, to educate people as much as possible to care for their own health and when their health fails to educate them to use the system and services available to them wisely. On the first half, educating people to care for their own health, we have had our healthy lifestyles program. You have seen the media stuff, you have seen some of the stuff that has gone around in the schools, the little playlets we have. We have also had some very specific disease target population education programs. I am sure all of you are familiar with our AIDS information programs, the AIDS hot line, the AIDS advertisements and that kind of thing.

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In terms of educating the providers, this is of course something we have to do in partnership with the providers themselves. We have developed a very impressive array of programs and program ideas now with the various provider organizations, be they hospital or community, professional, physicians or health care workers, and we can go over that list.

But there is one you did not mention, which I would like to perhaps bring into this. We are a system, generally -- and that separates us even from our European counterparts -- that relies very heavily on citizen governance. Hospitals are governed by citizens; our public health boards have citizen governance. The participation of citizens themselves in the governance of health services is a direction which almost every Premier's Council and royal commission has recommended and encouraged, including the most recent recommendations from the Premier's Council on health.

Last year we embarked on a program of educating those citizens who are in public governance positions. It was one of the most well-received education programs. We educated these lay members who sit on the professional self-governing bodies and lay members who sit on boards of health. We have now been asked to try to expand that education process to deal with all citizens who are appointed to various boards that have a governance responsibility in the health care sector. We think that is probably a very significant area of public education that hitherto we have overlooked. That was an idea, by the way, which came from the board members themselves, so it is simply listening to them and responding to them.

Mr Jamison: There are a couple of questions I would like to explore with the minister, and they are rather pertinent as far as I am concerned, about the funding of health in this province, but I would like to make a comment that we are an unmanaged system and we can probably bring in a better way to manage the system. I really believe that.

The questions I am about to ask deal with the situation across the border, in the United States, and how hospitals there seem to be -- we ran into stories a while back in the papers about hospitals actually advertising to Canadians to use their particular hospitals; our problem with drug and alcohol rehabilitation. That particular situation is the initial question I would like to address and have you give me a feel about where we can go, what our thoughts are on that and what kind of drain it is causing to our system.

The second part of the question deals directly with transfer payments from the federal government -- it is my knowledge that transfer payments have been consistently cut by the federal government; it looks like that is an ongoing theme -- and what effect that will have on our ability as a province to generate the revenues to actually replace those essential funds that allow us to better operate a health care system.

Hon Mrs Gigantes: First, I will speak very generally on the second question; that has to do with what kinds of sources of funding are available through our arrangements with the federal government. Those very questions now sit before the government and will have to be answered in an overall response to our agreement with the federal government and our working with other provinces to find long-term arrangements when existing arrangements run out.

We have been dropping in terms of the level of funding we receive for the health services we provide in this province. It is a serious problem and the government will be addressing that along with the question of funding for post-secondary education as one part of the established programs financing arrangements that are made with the federal government. Those will have to be renewed within a year, as I understand it, so we will be taking a position that will try and accommodate not just health funding but also post-secondary funding, and work to achieve some kind of overall position that the provinces will take.

As you are aware, as one of the three have-not provinces in the country, we have been subject to some special constraints in terms of the funding that is available from the federal government. We will have to work from that position, but it is a serious problem. Quebec has worked out special funding arrangements over the years with the federal government. It has taken tax points in lieu of flows of money. It may be that that is one of the ideas that will be pursued, but the Treasurer can speak better to this, so we will give him our full attention when he asks for advice. We need money in our system.

To get back to your first question, which is out-of-province treatment, it is a complex area. Out-of-province treatment has provided a safety valve for Canadian health care services in general and in Ontario quite specifically ever since we first had health insurance. It has been very useful in areas where we have not built up a level of specialist services in one area or another, to give us time to provide a base level of service in Ontario when that has been required. It has created crises in some areas of service, but those crises, I think, reflect the problems we have had providing service within Ontario.

I spoke earlier of coronary surgery. We now have the capability in Ontario to provide within an appropriate time length, at this time, for coronary patients in Ontario. That is a satisfactory position for us to be in. That is not true in the area of drug rehabilitation and alcohol rehabilitation programs, and it is not true in terms of head injury therapies.

We need to build those services and at the same time we need to develop the mechanisms that can help us stop a system which has been left in many instances to self-referral. For example, if I decide that I need rehabilitation therapy because I have a drug problem, I do not need a doctor to refer me currently for American service. We can put regulatory measures in place that will help control that self-referral system.

We are working very hard in the Ministry of Health now to develop an overall proposal for out-of-province treatment, the control of costs and the assurance of quality for out-of-province treatment. We need to do a lot more work in the areas where we are missing service and we still need to have a better handle on the use of the system out of province, if I can call it the out-of-province system, by Ontarians. I think it is safe to say we are building our knowledge on who is using those services and in what circumstances, and what methods of control we should be placing in that system to make sure: (I) that we are not having Ontarians refer themselves outside Ontario when that is not necessary; (2) assuring that when Ontarians do seek service outside Ontario, it is good quality; and (3) that when Ontarians get service outside Ontario, we are not paying too much for it. I think all those areas are problems currently, and we are developing policy which I hope will be before the government and ready for implementation before too long.

Mr Jamison: That answers my question. My problem with the initial question was that it has really concerned me that the opinion is that some private health establishments in the United States are considering our system somewhat of a cash cow. It would be to their benefit to tap into our system to the maximum degree.

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Hon Mrs Gigantes: We have set up some rudimentary reviews of particular institutions and particular patterns of use through the OHIP billing system in which we are beginning to inquire in rather strenuous ways about certain provisions of service and the cost of those services.

The Chair: I would like to interject at this point. We are running 20 minutes over and there are a number of other people who have questions. So I would need guidance from this committee at this point as to whether we would like to continue. We have two more presentations. Do we give up part of our lunch hour in order to continue to give fair hearing to everybody, or do we terminate the questions at this point for Health? I need guidance from the committee.

Mr B. Ward: We move along.

The Chair: Is there a consensus to thank the Ministry of Health for coming?

Mr Phillips: We are asked to recommend some budget numbers. My initial question still has not been answered and I may not have it today, but I think the committee needs some ideas to meet the objectives of the ministry, how much money are we talking next year? Because otherwise we are absolutely flying blind and this is a third of your budget here. I thought we would have some idea. Are we talking about $16 billion or $15.5 billion next year?

The Chair: Perhaps we could ask them to send along some budget projections in rough numbers for us so that we can consider those.

Hon Mrs Gigantes: The answer at this moment is that we do not have a figure that we can give to you. We are working on budget preparation ourselves.

The Chair: Whatever numbers you can provide the committee, I think, consensus-wise would be appreciated and as soon as possible too.

ONTARIO PUBLIC HEALTH ASSOCIATION

The Chair: The next presentation is the Ontario Public Health Association. I would like to thank the presenters for coming, Suzanne Jackson and Ronald Labonte, past president. You can begin your presentation now, please.

Ms Jackson: The Ontario Public Health Association is a 3,000-member organization of community and public health professionals. Our principal goal is to provide leadership and a unifying voice for public health in Ontario. The principal goal is in order to maximize the health of all Ontarians through the development of effective public health, health promotion and disease prevention strategies.

We appreciate the opportunity to speak to you. The structure of our argument is that we would like the government of Ontario to reorient its health policy from one of investments in health care to one of investments in health. We have some suggestions for that. Within the health care allocations themselves, we believe that the emphasis should be shifted from physicians, drugs and hospitals to community-based models.

That is a difficult decision to make, to hold the line on health care spending and to increase it in the community side. So we are arguing that we should initiate community level discussions to talk about the tradeoffs necessary between obtaining the best level of care for an individual patient and how much that compromises the level of health for the greatest number of people who live in Ontario.

Our first argument is that we should be spending less in health care and more in the creation of health. This is based on the concept that was presented by the previous speakers, the deputy and the Minister of Health, that public policy measures are much more fruitful for creating health. One's personal health is much more dependent on environmental quality, supports for child development, income adequacy, employment opportunities, housing adequacy, physical safety and security and food availability.

If these things are the determinants of health and if we are going to create health in the province, those are the areas we need to be moving on. Unfortunately, we believe that the continued increases in the health care portion of the budget provincially have taken away the ability to make policy decisions and increases in the areas which we believe would be more productive in terms of increasing people's health.

We recommend that the government not increase spending in the hospital, physician and drug benefit services in 1991-92 and that over the medium term the government progressively decrease spending in these envelopes relative to spending on the determinants of health.

There are many health determinants you could spend your time on and debate spending your efforts on. We have concerns about environment. We have concerns about income, employment, food, all of those areas. In particular, we emphasize that increasing investments in social welfare reform is a specific and urgent example of our belief in the need to develop a comprehensive provincial health investment strategy, an investment in health as opposed to health care.

We noted in previous briefs to this committee that the cost estimates of full implementation of the Social Assistance Review Committee recommendations would have far greater long-term cost savings than similar expenditures within the hospital and physician service sector. So we believe it is of vital importance that this budget affirm the new government's commitment to full welfare reform.

We call upon the government to announce in its 1991-92 budget a timetable for full implementation of the SARC recommendations. We realize that they cannot all be implemented in one year, but we think that it should work out a staged process for implementation of those reforms as a major step towards creating health for the people of Ontario.

This is supported by work in other nations. Again, that was referred to in the deputy's paper, that those having the greatest after-tax income equality have the lowest infant mortality rates and the longest life expectancies. This is independent of the absolute level of income within the country. So we believe that government policies supporting income redistribution, such as welfare reform and more progressive income taxation, are vitally important public health policies.

That is our picture of the overall budget in terms of trying to shift and put more emphasis on policies which create health. Within the health care envelope itself, we would like to shift the emphasis from institution to community-based models. There are three ways in which a shift to community-based models can improve public health.

One is that community-based care may lead to reduced costs in the medium term. We emphasize that those will not be realized in the first few years and in fact you will have some doubling up of costs for a period of time. However, we believe that public health will be improved in Ontario to the extent that proportional savings in this province are directed towards greater funding of policy initiatives related to community care. We also believe that the natural networks of community and family support are more likely to be maintained through a community-based focus on health care and that that is very important.

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Recent research has found that the relative risk of mortality and morbidity for persons who are socially isolated is two to four times greater than for adults who have good social networks and support. It is very important that these natural networks of Canadian family support be supported and that local community governments allow for greater responsiveness to local health needs and issues. We believe that is an important aspect of the community-based system.

We recommend that the government increase its fiscal support to community-based models of health care service delivery. We also, as a corollary of that or a particular example of that, would like to emphasize support for the natural care givers.

One example of this is that, when we were sponsoring a series of public consultations on the government's proposed long-term care reforms, the Ontario Public Health Association was informed repeatedly that the ability of the natural care givers to continue in their role is made very difficult by the loss of employment income. To the extent to which we can support natural family and friend care-giving networks, it is economically less costly than professionally provided care or institutionalization. We recommend that the government provide direct payments and/or tax credits for compensation of forgone employment income to family care givers.

We recognize that this kind of direction that we are suggesting is a difficult line to walk politically. We recognize that the government, through its continued support of the Premier's health council, is aware of the decreasing benefits of putting more money into health care spending. We are getting a decreasing margin of utility by doing that.

The problem comes down to people who live in the province of Ontario who are concerned about access to health care and the best health care services possible, so their interest is in the best possible care for the individual patient.

When we are looking at it from a public health perspective, we are also seeing it from the broader outlook, which is that we should be looking for the most efficacious care that creates the greatest good and creates health for the greatest number of people in the province, and there is a fundamental contradiction there.

Again, the kind of tradeoffs that we are talking about match concerns that people feel who live in Ontario. People are increasingly concerned about the quality and sustainability of their physical environment, the fear of violence, the continued high cost of housing, especially in large urban centres, and other issues of social equity or fairness, and they are all dealing with the basic determinants of health. What Ontarians do not realize is that their parallel concern for access to the latest medical technology, hospital and pharmaceutical procedures can compete with their desire for a safe environment and a more equitable society.

What we are saying is that continued growth in the health care budget provides little or no marginal health return for the size of the investment, and in fact we would get a better bang for a buck if we invested more in policy areas that create health. We know this, you know this, but we are not convinced that the majority of Ontario citizens know this. Until they do, politicians and government budgets will continue to reflect a policy of health care investment rather than a policy of health creation investment.

We recommend that the government create the necessary political support for a health investment strategy for the province of Ontario by initiating a series of community forums on the ethical limitations of health care spending such that direction is provided to politicians, health care professionals and other public decision-makers.

That is the principal thrust of our argument. We have an addendum in that it is a long-standing public health policy that tobacco use is one of the single leading preventable causes of morbidity and preventable mortality, so we continue to support taxation policy recommendations.

I believe you have had or you will have a brief presented by the Canadian Cancer Society, the oncology society, heart and stroke, the Ontario Lung Association, non-smokers' rights, a consortium of these groups who are making recommendations for tobacco tax policy. We support those recommendations.

As an additional point with respect to supporting those recommendations, we would urge you to ensure that the total provincial tobacco taxation revenue matches or exceeds public expenditures related to tobacco product use, including disease treatment costs attributed to tobacco, fire safety protection costs, health education and promotion initiatives related to stopping smoking or tobacco use reduction, the cost of smoking cessation programs, the cost of research into medical treatments and the cost of foreign crop substitution and displaced tobacco worker job retraining programs. All those costs should be matched by the kind of revenue we are taking in in the tobacco area.

Mr Sutherland: I saw that you were in the audience when the Minister of Health and the Deputy Minister of Health were here. I was wondering if you would like to comment on any of the statements that they made about the transition process into this community care. You have urged us to go very quickly. The minister and the deputy minister said there is a problem in going quickly. Do you see there is a problem with going more quickly than maybe what the minister and deputy minister have indicated?

Mr Labonte: First of all, we regret that we actually were not here for the full comments of the minister or the deputy, but we reviewed the deputy's written comments. Our argument is basically that we believe that until such time as expenditures in the institutional sector are frozen, any proportional increases in the community-based sector are necessarily going to be small. They have shifted over the last couple of years and we have been very strong in commending the Ministry of Health in attempting to make this shift, but the sheer size of institutional budget means that it is a very small incremental gain.

We would argue that you need to close down institutional spending in order to build up that parallel system. That also would likely involve some tough negotiations with the federal government, because part of our problem is that the federal government gave us 50-cent dollars back in the 1950s to build the institutional side, not the community-based side. It is a matter of internal policy in the ministry, how they go about trying to make this change. Standing on the outside, we would continue to prod and goad that this change needs to occur quite rapidly. I do not know if that answers your question.

Mr Sutherland: Just one supplemental. How do you ensure that you still retain your quality of care within a quick transition process? That seems to be a bit of the dilemma that the minister and the deputy minister were pointing out.

Mr Labonte: A difficulty that underlies even that is that right now we do not have full quality assurance within the kind of care that is provided and we have this declining margin of utility in terms of what we are spending. So we do not even know that what we are paying for is giving us the quality that we want. Any time one makes a transition from one particular system of delivery to another system of delivery, there is going to be an awkward period where, yes, there is going to be some discomfort in terms of full or ready access.

That is why we underscored the necessity, because politically we recognize that politicians with their four- or five-year horizon are going to face the demands of their electorate. Their electorate often wants or equates their own personal health with their hospitals or with their doctors or access to these services. We know from research that we are not getting any return on that kind of service. Until the public begins to engage in that debate and begins to work with the government in making that transition, we are going to continue to have this imperative to put more money into the large capital expenditures on hospitals and other disease treatment.

Mr Christopherson: I apologize for missing part of your presentation. I had to arrange to get some cold medicine. I am rapidly deteriorating here with a cold a friendly colleague of mine passed along.

I appreciate hearing your presentation. Prior to coming here, I was chair of the regional health and social services committee and was very active in the healthy communities concept. I think that ties in very much to where you are going here. My question is just specifically on a budgetary matter. At the time I left regional council there was a great deal of enthusiasm in our community and in our council for the mandatory health program. The direction, the thrust, even the phase-in period seemed to be pretty exciting. Then the funding announcement came through. After the announcement, the reality: There was not enough money, at least in our region, to meet the three-year phase-in program that indeed had been approved by the Ministry of Health.

1140

Is that situation still alive? Are there still concerns about that and are you comfortable that the three-year target mandate -- it might have even been four, but I think it was three -- can be met, and any other comments you might have about that program vis-à-vis the healthy communities concept and everything you are talking about here, meaning that as a vehicle or one of the vehicles?

Ms Jackson: In our association, a great deal of our membership is made up of people who work in the public health sector. We definitely support the mandatory core program directions. We are concerned about the lack of funding commitment that went with the policy statements that we favour. That is part of the argument that we are making towards supporting community-based care, also to support community-based health initiatives such as the public health and community health programs.

If you want to know whether they can be implemented in three years, I think the three-year timetable has posed a lot of problems for many health units in the province. At the same time as they agree, many of them are very supportive of the recommendations and are trying to do something about it. I do not know if that answers you. We are very committed to supporting those directions and in fact are working on ways to enhance people's understanding of the best news that has occurred in public health in years. We are in favour of it but we are concerned with the lack of funding support for it.

Mr Labonte: The other thing too is that we wanted to be unique in coming to this standing committee and not asking for anything for ourselves --

Mr Christopherson: We noticed that. We appreciate it.

Mr Labonte: -- even though we recognize that we would like to have more funding in public health programs. The basic argument is that we would need to have funding in the determinants of health and that is compromised by institutional care spending and the rate of that spending, and we need to have within that envelope more shift over to smaller, community-based agencies.

Mr Christopherson: What is the first step? If you were given the chance to make one decision, a practical decision -- I am not talking about changing the world in one step. If you were asked and had the opportunity, what would be the first step that you would see us making down this road?

Mr Labonte: We actually have five very simple steps, which are our recommendations. The first is to sort of freeze the expenditures in the hospital, physician and drug side and announce the full implementation of the Social Assistance Review Committee because of the equity question and its incredible impact in terms of long-term health, because of the child poverty issue.

The shift to community-based is a little more difficult to measure, but what you would look at within the ministry budget is that the community mental health, the community health and public health budgets would increase significantly relative to the hospital, physician or drug benefits. Something I would really like to emphasize to this committee is the need to engage in community-level debates over the ethics of the total scale of health care spending, because even if you do quality assurance programs and you make sure that what you are getting is in fact efficacious, effective and efficient, you still have not raised to the self-conscious or political level the debate about the tradeoffs: If you put our money here, where are we not putting it in terms of other things which may be more vital or important to health?

Mr Christopherson: The only problem, and please accept this in the vein it is meant to be offered, is I really did not see that as a step. To me, that is the major leap. I mean, you are asking for all of it to be done in one fell swoop, and as a new member of government, I do not know how realistic that is. My experience even at the regional level tells me that something like that would be very difficult to do in one move, which is why I asked the question. If you could see one concrete, doable, solid step forward that really would get us going in the right direction, what would it be? But I appreciate and respect your answer.

Mr Phillips: One of your fundamental recommendations, which I think is an interesting one, is to shift the focus. I think, as we talked earlier, many of the commitments that have been made by the government go the other way. I think there are some major commitments to the Ontario Nurses' Association. Most of ONA works in hospitals, and that is an understandable commitment, and binding arbitration to physicians.

I think the minister earlier sort of rejected one of the major recommendations from the Lowy report on drugs, so your recommendation to shift the focus to community- based may be a little late, at least over the short term, because the major components -- hospitals, 75% are salaries for nurses and for staff, and I think both of those are fixed in place now, or close to it; the physicians with the binding arbitration, and the Lowy report major recommendations.

It may be very difficult for this government to act quickly on your first recommendation. I just make that observation because I think that will be a challenge for all of us. The fact of the matter is that there is incredible commitment already made to the institutional segment. But my question really is on the community-based. And I agree with you, and I think the minister said earlier they were going to shift and put more emphasis -- specifically what kind of money are we talking about and can you give us some examples of the groups that we should be looking at substantially enhancing support for to help community-based care?

Ms Jackson: Some of the community groups would be community health agencies, support for some of the informal care giver networks that we mentioned specifically in the brief. In many communities the hospital is a community centre, so there are outreach programs, there are possibilities other than focusing simply on the community health centre as an alternative. But it is working with other community agencies, including support for public health units and the long-term care reform recommendations which involve looking at both the kind of care that is provided through the Ministry of Community and Social Services, as well as through the Ministry of Health. So those kinds of agencies, as well, are important to support.

Mr Labonte: There is a polyglot of community-based agencies.

Mr Phillips: A what?

Mr Labonte: A polyglot; like a huge, strange, flotsam and jetsam floating around there; a variety.

I think what is important to understand about community-based agencies and what makes them a bit different -- because in some small areas a small hospital may in fact be a community-based agency and it may be the area of locus within that whole community where people sort of go for a variety of things besides just tertiary care. But in most instances hospitals are very large. They are kind of the analysis of the factory model and so forth.

A community-based system of care could be a community health centre that is probably about the best model that we have in Ontario right now -- like the centres locaux de services communautaires in Quebec. It is to some extent public health units, community health agencies that exist across the province. But what is important is that, first of all, a community-based agency has to be small enough that it does not become a huge bureaucracy that is inaccessible by the people in the community.

It has to have some direct, meaningful form of community governance so that community members actually sort of can run and make some decisions and try to integrate not just the tertiary issues of care but also some of the health promotion, disease prevention and public policy issues in care. It is easier to define it by what it should look like rather than what it actually is, because we are in that transitionary stage of trying to establish a network of community-based services to supplant our large institutional sector.

Mrs Sullivan: I wanted to pursue your point 1 on page 7 where you suggest that community-based care may lead to reduced costs in the medium term and then talk about longer-term effects later on. The expert analyses that I have read have indicated that in fact over the longer term Ontario ought not to expect to see a reduced portion of its budget committed to health care. What we would see is a difference in the delivery vehicles, but not a significant difference in the budget proportion. I wondered how you have reached this conclusion. It is certainly not one that the past government nor, I think, this government considers to be an appropriate conclusion.

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Mr Labonte: We acknowledge that when we say that estimates of eventual cost savings are speculative and subject to debate. The jury remains out on whether it is going to be simply a redistribution to other vehicles or whether there in fact will be a total savings within the envelope of complete health care expenditures. We acknowledge there is a lot of disagreement about that.

Certainly we say that in the medium term, as you are trying to set up a new system, the old system is also going to continue and also is going to require some funding. So you are probably going to have a period of a bit of economic growth that will occur as you try to set up the parallel.

I do not think that anyone, at this point probably, knows whether a community-based service delivery system is going to be cheaper for the same type of services. It may be, it may not be. Some evidence says it will be, other people disagree. That is why we tag on that final recommendation, because it still begs that question of, how much do the citizens of Ontario want to spend on treating disease, with relative declines in the margin of utility for their own health in that expenditure, if it is going to compete with the other sectors -- for example, the Environment ministry or in economic development, for things like jobs, a safe environment, adequate housing, safer quality food -- if it begins to compete with those determinants? That is why we believe quite strongly that this discussion has to begin to take place; otherwise we are going to continue to have discussions about how to allocate for health care spending rather than allocating for health.

Mrs Sullivan: Certainly in my community the longer-term analysis has been done in terms of the economic effect and cost of an integrated community-based funding delivery system, including some institutional portions, but as well, a lot of community-based services. Our view locally is that it will cost more than our current system is costing, given what the goals are at the end of the line and where we are going. So I wanted to pursue that.

I think that in terms of budget planning we would continue to be looking at about a third to 40% of the provincial budget being committed to health care, no matter what the delivery system. That is sort of what we are looking at in this committee.

Could you just comment on changes in impact, say, on human resources and the cost of delivering community-based services, as you are looking to change? I am thinking about things like impact of travel, say, for nurses or costs that might not now be factored into the system that even in the transitional phase may have to be factored in. Do you have any analyses of those kinds of incremental costs?

Mr Labonte: No, we do not. In fact, what you are actually proposing is something that would be quite exciting to do for the current system, as well as for any proposed new system. I think what you are doing is saying, "Let's begin to internalize to the extent possible what all the costs of maintaining the system are," because in your statement that the community-based care delivery versus the current system might cost more, one of the reasons -- and this is where there has been some research. It looked at community health centres and said that they may not be cheaper than fee-for-service physicians, but community health centres offer all kinds of things that fee-for-service physicians do not offer. They are less easily quantifiable, but they have various kinds of support programs, various kinds of community entry points to sort of begin to look at policy or shifting some of the environmental issues within their neighbourhoods. So they offer more than just what a medical system, as it is defined, offers.

To some extent, unless we are very clear about what we are comparing, then we might end up with eventual cost estimates that are kind of like apples and oranges. So when we look at this notion of internalization, I think we would want to do that within the whole hospital-based system or institutional-based system, alongside the community-based system, and then see what in the community-based system is being offered that is not currently being offered by the institutional system so that we can make an honest comparison.

The Chair: I would like to thank you for coming and for your presentation.

While we are having the transition between this group and the next one, an issue of some importance has come up. We have been requested by the Canadian Bankers' Association that it would like to come and make a presentation to us. They are past the deadline, but they would like to make the presentation anyway.

A second issue that has been brought up by Mr Kwinter is that the rate of bankruptcies in Ontario has been going up very rapidly. The question to the committee is whether we could find time to have somebody come and speak to us about bankruptcies. We could also invite the Canadian Bankers' Association to come and speak to us about this issue. Is it the will of the committee that this invitation be extended?

Mr Christopherson: Who would be the expert to talk about bankruptcies?

Mr Kwinter: Let me give you a comment. The Chairman passed me a note and asked me whether the banks were pulling the plug too soon and what we can do about it.

Mr Christopherson: On bankruptcy?

Mr Kwinter: Yes. It would seem to me that if we could get the Canadian bankers to come in here and address what they do about this thing -- what kind of tolerance do they have? Are they in a position, when times are tough, to maybe lessen their criteria or to do something?

Mr Christopherson: Maybe I misunderstood. I thought the Chair said there were the bankers and somebody to address bankruptcy.

Mr Kwinter: No. He was saying that the bankers have asked to come, and I do not think it has anything to do with bankruptcies. That is just a coincidence. They have just asked to come.

The other question is that this report that came from Canadian Press today says that bankruptcies in Ontario have grown by a whopping 81% over 1989, just a staggering number. It is something we should be dealing with. I do not really know who, other than a large accounting firm that has a very strong bankruptcy section, we could ask; someone like Ernst and Young or whoever. There are some firms that really specialize, unfortunately, in bankruptcies. It might be useful to have them come in and talk about what they see as the underlying cause, things of that kind, and see if we can address it.

Mr Christopherson: Exactly. Are you comfortable with mandating the Chair to work with the clerk and the staff to find one or two groups that could address that? Are you comfortable handling it in that fashion?

Mr Kwinter: Sure.

Mr Christopherson: If you are, I would prefer to move that we do allow the bankers to come in and that we mandate you, Mr Chair, to co-ordinate one or two groups to come in and address that bankruptcy issue. I think they are good suggestions on the part of Mr Kwinter.

The Chair: I take it there is consensus to move in that direction? Thank you.

The Acting Chair (Mr Sutherland): The Chair has just had to step out for a minute so he has just asked me to take his position, if there is no objection from anyone. Our next presenter is Mr Howes.

TERRY HOWES

Mr Howes: Perhaps we should put my little presentation over until after lunch. You have had a long morning; I mean, in fairness to me and to you. I have important things to say.

The Acting Chair (Mr Sutherland): No one is going to deny that you have important things to say. We have a presentation at 1:30. I am at the will of the committee on this one.

Mr Christopherson: On a point of order, Mr Chair: To hold Mr Howes over until this afternoon would not work at all, because all the slots are filled. However, are there -- I know we have been having a real time problem -- other possibilities for a slot for Mr Howes?

Clerk of the Committee: At this point, the last time slot is on the morning of 4 February to accommodate those who are on waiting list. We are into the third week of hearings.

Mr Christopherson: That would probably be your best bet.

Mr Howes: Listen, I promise I will not bore you. I have about a 15-minute presentation.

The Acting Chair: We can do it right now and we will allow time for questions as well.

Mr Howes: Good. I hope you have some, too. I feel more comfortable standing, so if you do not mind I will.

The Chair: You will have to sit down, because the mike will not pick you up.

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Mr Howes: The Unclaimed Intangible Property Act was given royal assent 19 December 1989. All three readings were given in a 14-day period, something that as far as I have ever heard was unprecedented, yet 13 months later the act has not been proclaimed. I was the one who brought this situation to the attention of the former Chairman, the fact that there was all kinds of money that should probably belong to the people of Ontario that was being used by others, whose money it was not.

I was very interested in why this act was not in force. I found out that there has been intense lobbying going on in this Legislature, lobbying by the most powerful money people in this country, with a lot of clout. I made a freedom of information request and months later I got copies of their presentations.

It is a real blue ribbon group, I will tell you. You cannot get any more blue ribbon than this: the Canadian Bankers' Association, which is going to be appearing here in a couple of days, and I would like to hear what they have to say on this topic in particular; the investment dealers; the Insurance Bureau of Canada, that is the insurance companies' lobby group; the investment funds; Canada Trust; National Trust. The list goes on and on. Here they are. Believe me, it is not bedside reading. It took a lot of plowing through this.

One is of particular interest. This is the one from Royal Trust. Try to make any sense out of that.

The Chair: You are going to have to sit down, because we cannot get it on the record.

Mr Howes: Try to make any sense out of that. The pièce de résistance is the last page. All it says is appendix 1 and not another word. Royal Trust is a member of the Bronfmans' Hees International Bancorp. Some would say they must have something to hide.

Anyway, there is one thing in common to all these presentations, to every one of them. They do not want this law. They do not want it to begin with but, second, they most assuredly do not want it to be retroactive.

The trust companies' trade association was the most vehement about this. They sent in no less than seven letters and submissions. I am going to quote short quotes from some of these submissions and I hope you will listen to me because some of them are pretty convoluted. They are in bureaucratese, not people talk. I will translate it in a minute.

"It is the long-standing practice of the industry to bring many types of unclaimed property into income. There should be no retroactive effect to the program."

Finally, after l0 months of lobbying and figuring that they had it anyway, they bit the bullet and allowed as how they could put up with a five-year retroactive period. I am going to show you that the retroactivity and the kind of money involved is mind-boggling. Anyway, they finally allowed as how they could live with five years.

Canada Trust in its presentation said that unlike the banks, "there has not been previous legislation in Ontario governing the transfer of unclaimed properties." With the chartered banks, as we all know, if an account is dormant for l0 years, the money must go to the Bank of Canada. Not our trust companies. Our trust companies just keep it. Believe me, they make no try to find the people whose money this is. I know what I am talking about, because that is my business.

National Trust is particularly interesting. They said, "It is a general practice for certain unclaimed balances to be taken into income." This is the punch line; it is really good. "We feel strongly that the present system of administering unclaimed funds is sound and effective." I do not blame them for feeling that when you consider what is in it for them. No wonder that Hal Jackman guy is so rich. They even threatened us with a constitutional challenge to the act. It is all in these presentations, every word of it.

The insurance companies' trade association is very interesting too. They said that, "retroactivity of legislation of this nature, which is in effect a tax, is contrary to our parliamentary traditions." As we all know, only profits are taxed, so obviously our insurance friends regard this money as pure, clear profit. Their rationale is very interesting and very convoluted, so you have to listen carefully to it because it is quite funny.

"The general thrust of Bill 86 is to safeguard in perpetuity the rights of the owners of intangible property while at the same time allowing the use of intangible property for the benefit of the people of Ontario." That sounds great, like motherhood.

In reality, this is precisely what these fine folks do. "By investing these funds in various public and private instruments in the province of Ontario, the income earned on these funds helps to keep general insurance premiums at low levels." I think car drivers would question that part of it. "Thus, as it stands, the Ontario public benefits in two ways. First, the funds are used to finance the provincial economy and, second, help to bring about lower insurance premiums."

What they are saying really is that our insurance friends know better than the elected representatives of the people what to do with insurance policies which have not been claimed. We are talking about a lot of money.

London Life asked -- what a nerve -- "that you exempt our industry from the act's application." They did not say why; they just asked to be exempted.

All of these companies operate in Quebec, every one of them. In Quebec, for many years they have had a law called the Public Curatorship Act. The public curator is the equivalent of our public trustee. All moneys from life insurance policies that have not been claimed go to the public curator and have for years. Yet they ask us here in Ontario -- we are so dumb -- that they should be exempted from it.

Under Ontario's Insurance Act, it says -- without boring you with the reading of the legal doubletalk -- that an insurer may apply to the court for an order for payment into court. He may do it, not that he must do it. Believe me, they do not do it. The operative word is "may." They just keep the money.

To give you an idea of the kind of money we are talking about, this was an ad that was in the New York Times, 9 April 1990. You need a magnifying glass to read that thing, but that is one company, the United States Life Insurance Co, in one state. Those are people who had not claimed their life insurance policies and all this money went to the state -- one company, one state. We are talking megabucks. In New York state in 1986, which is the latest year for which I have figures, $5.7 million went from life insurance companies to the administrator of abandoned funds in that state.

The Insurance Bureau also finally admitted that it could live with five years of retroactivity, but I am going to try to make a point and convince you that that is nowhere near good enough.

The investment dealers' association is a little more candid. They say, "The practice has been to bring the balance in the unclaimed property account into income of the dealer." They have a lot of money from dividends that people do not claim. The stock is in the broker's name and they do not know whose money it is. There is a lot of it.

"The proceeds from unclaimed property may have been distributed long ago to the shareholders of the dealer." In other words, they just helped themselves to it. At least they are candid enough to say it.

Barclays Bank: Let me quote from their presentation, "Our objection is that when applied to travellers cheques the act results in an unjustified confiscation by the government of part of the sole consideration which is received by the issuer of travellers cheques for the services it provides." In other words, they count on people not cashing these travellers cheques and they just keep the money.

1210

Mind you, they do not point out that American Express has just made heaps of money. They live with the US law and in every state of the union, I should say 48 of the 50, the money for these uncashed travellers cheques goes directly to the abandoned property, but Barclays does not think it can afford to do that.

The racetracks of Ontario, now they are a great group, but at least they are really candid. They say they just help themselves to these uncashed cheques, and they out and out say it; not only that, but they give the figures. They are really good people. The Ontario Jockey Club right here in Toronto, for example, in 1989 scored $966,000. Would you believe it? How many of you throw away those tickets? I have done it loads of time. Well, it was $966,000 in 1989. No wonder the late E. P. Taylor liked to own racetracks. Anyway, ladies and gentlemen, I respectfully suggest to you that with their own words we have caught them with their hands very, very deep in the cookie jar.

Last November Premier Bob Rae said, "We're practical people who frankly can add." He was referring to his NDP colleagues and I sure hope they can, because I can convince anybody that we have at least $200 million that we can scoop for the good people of this province by applying this act retroactively as it presently reads. That is what it presently reads. We do not have to change a thing.

The abandoned money belongs to the government of Ontario; at least, the government of Ontario and the people of Ontario have a better claim on this than anybody else. This goes back in the common law to the Middle Ages, that abandoned property belonged to the Queen. I suggest we tell our friends here -- look at them all -- "Here's what we're going to do. You know perfectly well from your books over the years -- and don't tell us you don't, because money this is. I know what I am talking about, because that is my business.

National Trust is particularly interesting. They said, "It is a general practice for certain unclaimed balances to be taken into income." This is the punch line; it is really good. "We feel strongly that the present system of administering unclaimed funds is sound and effective." I do not blame them for feeling that when you consider what is in it for them. No wonder that Hal Jackman guy is so rich. They even threatened us with a constitutional challenge to the act. It is all in these presentations, every word of it.

The insurance companies' trade association is very interesting too. They said that, "retroactivity of legislation of this nature, which is in effect a tax, is contrary to our parliamentary traditions." As we all know, only profits are taxed, so obviously our insurance friends regard this money as pure, clear profit. Their rationale is very interesting and very convoluted, so you have to listen carefully to it because it is quite funny.

"The general thrust of Bill 86 is to safeguard in perpetuity the rights of the owners of intangible property while at the same time allowing the use of intangible property for the benefit of the people of Ontario." That sounds great, like motherhood.

In reality, this is precisely what these fine folks do. "By investing these funds in various public and private instruments in the province of Ontario. the income earned on these funds helps to keep general insurance premiums at low levels." I think car drivers would question that part of it. "Thus, as it stands, the Ontario public benefits in two ways. First, the funds are used to finance the provincial economy and, second, help to bring about lower insurance premiums."

What they are saying really is that our insurance friends know better than the elected representatives of the people what to do with insurance policies which have not been claimed. We are talking about a lot of money.

London Life asked -- what a nerve -- "that you exempt our industry from the act's application." They did not say why; they just asked to be exempted.

All of these companies operate in Quebec, every one of them. In Quebec, for many years they have had a law called the Public Curatorship Act. The public curator is the equivalent of our public trustee. All moneys from life insurance policies that have not been claimed go to the public curator and have for years. Yet they ask us here in Ontario -- we are so dumb -- that they should be exempted from it.

Under Ontario's Insurance Act, it says -- without boring you with the reading of the legal double talk -- that an insurer may apply to the court for an order for payment into court. He may do it, not that he must do it. Believe me, they do not do it. The operative word is "may." They just keep the money.

To give you an idea of the kind of money we are talking about. this was an ad that was in the New York Times, 9 April 1990. You need a magnifying glass to read that thing, but that is one company, the United States Life Insurance Co, in one state. Those are people who had not claimed their life insurance policies and all this money went to the state -- one company, one state. We are talking megabucks. In New York state in 1986, which is the latest year for which I have figures, $5.7 million went from life insurance companies to the administrator of abandoned funds in that state.

The Insurance Bureau also finally admitted that it could live with five years of retroactivity, but I am going to try to make a point and convince you that that is nowhere near good enough.

The investment dealers' association is a little more candid. They say, "The practice has been to bring the balance in the unclaimed property account into income of the dealer." They have a lot of money from dividends that people do not claim. The stock is in the broker's name and they do not know whose money it is. There is a lot of it.

"The proceeds from unclaimed property may have been distributed long ago to the shareholders of the dealer." In other words, they just helped themselves to it. At least they are candid enough to say it.

Barclays Bank: Let me quote from their presentation, "Our objection is that when applied to travellers cheques the act results in an unjustified confiscation by the government of part of the sole consideration which is received by the issuer of travellers cheques for the services it provides." In other words, they count on people not cashing these travellers cheques and they just keep the money.

1210

Mind you, they do not point out that American Express has just made heaps of money. They live with the US law and in every state of the union, I should say 48 of the 50, the money for these uncashed travellers cheques goes directly to the abandoned property, but Barclays does not think it can afford to do that.

The racetracks of Ontario, now they are a great group, but at least they are really candid. They say they just help themselves to these uncashed cheques, and they out and out say it; not only that, but they give the figures. They are really good people. The Ontario Jockey Club right here in Toronto, for example, in 1989 scored $966,000. Would you believe it? How many of you throw away those tickets? I have done it loads of time. Well, it was $966,000 in 1989. No wonder the late E. P. Taylor liked to own racetracks. Anyway, ladies and gentlemen, I respectfully suggest to you that with their own words we have caught them with their hands very, very deep in the cookie jar.

Last November Premier Bob Rae said, "We're practical people who frankly can add." He was referring to his NDP colleagues and I sure hope they can, because I can convince anybody that we have at least $200 million that we can scoop for the good people of this province by applying this act retroactively as it presently reads. That is what it presently reads. We do not have to change a thing.

The abandoned money belongs to the government of Ontario; at least, the government of Ontario and the people of Ontario have a better claim on this than anybody else. This goes back in the common law to the Middle Ages, that abandoned property belonged to the Queen. I suggest we tell our friends here -- look at them all -- "Here's what we're going to do. You know perfectly well from your books over the years -- and don't tell us you don't, because we know you do -- buried in your books it says how much money each year you have scooped from unclaimed property." And you believe that every single one of them would know it. Let them keep the interest they have earned on this money over the years. Can you imagine what it would amount to? There were years when interest rates were at 20%; this money would have doubled, tripled, quadrupled and dear knows what. Let them keep it. Give the capital to this province to ease the burden of the taxpayers of this province.

That is my presentation, ladies and gentlemen. I respectfully give it to you. I know what I am talking about. I hope you have some questions.

Mrs Sullivan: Mr Howes, I am familiar with the presentations you made some time ago to Mr Nixon before the bill was introduced and I wonder if could you give us some estimate of your experience, although you have been operating in the private sector, of the collection costs?

Mr Howes: Yes, I sure could.

Mrs Sullivan: Okay; I think that would be interesting.

Mr Howes: You will have to bear with me for a moment, Mrs Sullivan, because I have it here. It is approximately 6%. There is only one state that breaks it down.

Mr Sutherland: There is reference in your brief here. It says New York has 6%.

Mr Howes: I do not think it is New York.

Mr Sutherland: On the very last page.

Mr Howes: Yes, 6% and, after all, surely that sounds like a reasonable sum. What is involved, after all? We tell these custodians, "Come up with the money." In the state of Pennsylvania they have quite a few collectors out beating the bushes, getting this money in, and they found that it works great, because it will come as no surprise that people are not too keen on shelling it out. Does that answer your question?

Mrs Sullivan: Yes, thank you.

Mr Howes: It is the only state I can speak of, but common sense says that it should not be very expensive. It is one big money spinner. It is the second-largest source of income for many, if not most of the states. We are talking about big, big money. Would somebody like an estimate as to what we would get in this province, because I can give it to you?

Mrs Sullivan: I suppose I was asking the question because I was just doing some calculations. You have talked about the jockey club, for instance. They plow, say, $1 million a year back into their revenues. They also receive funding from the province, so presumably provincial funding would have to be made up for the lack of the availability of that $1 million.

Mr Howes: It is a profit-making organization, Mrs Sullivan. I do not know why it should be.

Mrs Sullivan: That is interesting.

Mr Howes: E. P. Taylor, God rest his soul, was no public benefactor and he controlled it.

Mrs Sullivan: We could argue about that, but I am thinking about the context of an Ontario Jockey Club operation or the Ontario Racing Commission which receives funding and probably would have to get more funding; I do not know.

Mr Howes: Mrs Sullivan, with respect, I would suggest that perhaps we should speak more of where the really big money is, the trust companies that fought so hard not to have it retroactive, and the life insurance companies in particular. We are talking about so much money. Would anybody like a very calculated guess as to how much we are talking about? Would it interest you?

Mr Sutherland: Actually, that was my question. You said $200 million retroactively.

Mr Howes: I am being really conservative.

Mr Sutherland: I want to know what your estimates would be on an annual basis, ignoring the retroactivity.

Mr Howes: At the very least $25 million, and probably double that on an annual basis. Let me tell you how I arrived at this figure. Delaware gets in $10 and change per person. New York gets $11 and change per person. The reason for that is that Delaware is the major state of incorporation of companies in the US, as is New York the major commercial centre.

Ontario is both those things, so we have every reason to think that our take should be approximately theirs, not to mention that this is a major resource province and there is much income from the likes of gold mines and so on. Believe me, it is my business. I know what I am talking about, ladies and gentlemen, I really do. Anyway, cut it in half. Supposing we can only do half as well as New York or Delaware. That is $5 per person times nine million or $45 million on a continuing basis. All kinds of money slips through the cracks. I make my living out of it.

Mr Kwinter: I would just like to make a couple of comments. I have no problem with the act as it was passed -- I am glad -- and I have no problem with the concept. Where I do have a problem is that you have painted it absolutely black and white and it does not work that way. Let me give you the reverse, to use your analogy and to put it in the simplistic terms that you have placed.

Mr Howes: I did not understand it any other way, Mr Kwinter.

Mr Kwinter: Let me just give you an example. At the present time you are talking about all of these unclaimed assets, that if we had only clamped down and got them all, we would have this $25-million bonanza, whatever it is.

Mr Howes: Much more, hundreds of millions.

Mr Kwinter: Whatever, that is fine, whatever the amount is. On the other side, we have a situation in our economy where every major retailer, whether it be Shoppers Drug Mart or Canadian Tire, factors in as a fact of life that they have shoplifting, and shoplifting ranges anywhere from 6% to 10% to 12% of their annual sales. The costs are staggering. You could make exactly the same argument that, my God, if we could only have armed guards at every single store and put everybody under surveillance and do a strip search, we would save this economy incredible amounts of money.

What I am saying is that what you are saying, in principle, I agree with, but I think there is another factor. Let's use your example of the jockey club. The jockey club is not hiding the fact it has this money. It is not saying, "This money is something we put in our pocket." It declares it in its statements and it says that for every dollar that is spent, there is X% that does not get claimed. It uses it as income, but it is also liable. In 20 years' time, if you come back and you have that ticket, it will pay it.

I am not justifying the fact it is using it, but what I do resent is the fact that you are implying that E. P. Taylor and his heirs have this sort of scheme going where they are pocketing this money. What is going to happen if that money does revert -- and under the act, it would -- to the crown? It will then say: "Traditionally and historically we have had X dollars available to us in our operations. We don't hide it. We declare it. We show it. If we don't have that, then we're going to have to compensate. We're going to have to increase all of our charges to make up that shortfall."

I can tell you -- again it just happens we are talking about an area I am very familiar with -- contrary to what you are saying, the racing industry in Ontario does not make a lot of money. The Ontario Jockey Club in particular is a non-profit organization and it really is. I am not crying for these guys, because I can tell you that if you are poor you are not in that business. It is the sport of kings. It is a rich man's hobby. But if anyone thinks they are getting into the racing business to make money, he will be sadly mistaken. The people that are in it are in it because it is something they enjoy doing and they -- whatever turns you on.

The point I am making is that it is not just black and white. If you flip it from one side of the balance sheet to the other there will automatically be a compensation. Whatever industry it is, whether it is the insurance industry or whatever else will say: "Fine. We've had this money. We declare it. We show it. We use it as part of our operating expense."

Mr Howes: No, they do not declare it and they do not show it. Believe me, they do not.

Mr Kwinter: I think it is on their balance sheet. I cannot see how it cannot be.

Mr Howes: No, sir, it is not.

Mr Kwinter: How could it not be? The banks all show it.

Mr Howes: That is because the banks have to send it to the Bank of Canada.

Mr Kwinter: I know, but I used to be the Minister of Financial Institutions. I can tell you --

Mr Howes: Mr Kwinter, that is my business.

Mr Kwinter: It may be your business, but I am telling you that when an insurance company has income and expenditures, it is audited. They are subject to inspection by the department of insurance, and if there is an amount in there it is shown, It is shown as unredeemed benefits, whatever. There is a figure in there.

I am not saying that they are not benefiting from the interest that accrues and all of that stuff, and you may not agree with it and I do not agree with it. That is why the act was passed. We are not arguing. I am just saying that you are portraying these people as somehow or other being involved in some subterfuge. All you are doing is you are arguing the principle that that money should not be theirs, and that act addresses that. Your next argument is why it was not proclaimed. That I cannot answer.

Mr Howes: I can. I can answer it. Do you want to ask me?

Mr B. Ward: I just have a quick question, Mr Howes. Tough economic times are facing the province. We are exploring all avenues of increasing revenue or opportunities for revenue and you are suggesting that this is one avenue that should be explored and examined, and the fact that there is a bill drafted makes it that much easier.

Mrs Sullivan: It is passed.

Mr B. Ward: It is passed? It was just never proclaimed. Why was it not proclaimed, in your opinion?

Mr Howes: Exactly.

Mr B. Ward: It is on the books. I do not know. But that this is something that we should look at as a committee is what you are trying to say.

Mr Howes: That is what I am begging you to do, and not to go for this baloney about the retroactivity. I beg you, have no pity on them. They do not deserve it.

Maybe a case could be made for the racetracks, Mr Kwinter. Let them keep their million a year. But how about Hal Jackman and his National Trust? Should he be here rattling a tin cup? Or put it this way -- I tell you, the essence of the problem is this: Can these people, whose money it is not, handle it better than the elected representatives of the people of this province? That is what it boils down to. It is not their money. They should not have it. Can they handle it better? Can these insurance companies? Do you take pity on them?

The Chair: I would really rather not get into that philosophical debate here. Are there any other questions? Seeing none, I would like to thank you for bringing this issue to our attention and I am sure we will be debating this again a little later on.

Mr Howes: Listen, when they turn up, would you ask them? Ask them. It is all here.

Interjection.

Mr Howes: Isn't that a laugh? Do you want to see it? Here, this is a classic.

The Chair: For the entertainment value, if any would like to continue the discussion with Mr Howes, that is fine. I am going to adjourn this committee until 1:30 pm; we have moved things up a little. So thank you very much. We will see you.

The committee recessed at 1225.

AFTERNOON SITTING

The committee resumed at 1341 in room 228.

The Chair: Just prior to beginning the afternoon session, I would like to read the response from the governor of the Bank of Canada to our request that he come to meet with us and, failing his coming to meet with us, to send a designate to meet with us. I will circulate this and I will just read the part that I believe is pertinent:

"While the Bank of Canada has of necessity to limit the number and scope of public appearances by the governor and other officers, it nevertheless firmly subscribes to the view that its policies and actions should be widely available to public scrutiny and discussion. To that end, above and beyond his appearances before Commons and Senate committees, the governor gives public speeches on monetary policy and the economy on a regular basis. The bank also publishes regularly that part of the minutes of its board meetings having to do with economic and financial developments and monetary policy. I can add that the governor's annual report to the Minister of Finance also represents a key element of the public record and is usually discussed at public hearings of parliamentary committees once it has been tabled in Parliament.

"Accordingly, while it is not possible to meet your specific request, I would be most happy to send to you or to Mr Decker forthwith a full range of the material to which I have just referred, if you, as we, think it would be helpful. My telephone number..." and so on.

I will put on the record my own view of this. It is that while all this information is useful and I think we should request it, I do not believe it will answer the salient question that this committee must deal with, and that is the projections of the Bank of Canada for the coming year, and the questions I feel we could have asked, being what does he foresee the value of the Canadian dollar being, the interest rate and the growth of the economy by the end of the year?

Would any other members like to have their comments on the official record?

Mr B. Ward: Just for clarification, we are requesting the material that the Bank of Canada is willing to provide to us? Is that right?

The Chair: Yes, we are.

Mr Christopherson: Just briefly, it is just disappointing that when this committee and the government, quite frankly, and the Treasurer, have gone to such great pains to talk about public consultation, to go through a procedure that allows everyone to have a say -- and we have heard that from the people who have come before us -- an integral part of that is the federal policies of the national bank and they have not come forward to expand on those issues and allow us a chance to question them. I realize they are concerned about this being an inquisition, but that is kind of the political downside of an open, public process.

It just needs to be said that it is a great disappointment that the Prime Minister would support and allow that type of attitude and approach to a serious provincial initiative such as pre-budgetary consultation in the fashion that we have undertaken here. I do not think it would be inappropriate for a letter -- procedurally, I do not know if I am in order or not; I would look to those who have been here much longer than I -- from you or from an appropriate minister to express our disappointment to the Prime Minister that there is not even a delegate here. I can understand if the individual cannot attend, but that not even a delegation would be here, since we are hearing that federal interest rates and the federal dollar have such a significant impact on everything we are looking at. I would hope we could take something stronger in terms of action other than just putting on the record our official disappointment.

The Chair: I would entertain that in the form of a motion, if there is a seconder. Is there any discussion on that? Do we have consensus on that?

Mr Sutherland: Just as a point of clarification, is not the Bank of Canada governor under the Minister of Finance? So probably it should go directly to the Minister of Finance.

The Chair: Copies to both?

Mr Sutherland: Sure.

Mrs Sullivan: I think you have to be careful about looking silly in these things. The governor of the Bank of Canada is not subject to the whim of this committee. It is a national body. He reports to Parliament through the Minister of Finance. We want to see a policy direction rather than an opportunity for grandstanding, a policy direction that is a result of policy decisions coming out of the federal government. It may be appropriate to invite Mr Wilson to appear, because that clearly is where the policy is coming from. I think we have to be realistic about the role of the Bank of Canada and its ties and obligations to a committee such as ours, as well. You might want to invite Mr Wilson to appear.

The Chair: Do we have a consensus on inviting Mr Wilson to appear?

Mr Christopherson: I agree with just about everything the previous speaker said. I am just as concerned, maybe even a little more so, about how we might look publicly since I am a member of the government side of the House. Obviously, if anything looked political, it would be to invite the Finance minister. Again, the intention, at least on my part, was not to bring in someone from the bank to grandstand or put him on the spot, but I would really like to hear first hand his rationale, not just a policy paper. But we could also put the kind of questions that are being put to us, especially in the area of the high interest rates and the dollar.

I do not profess to be an expert on the federal economic system. However, my understanding is that Mr Wilson has continually taken a position, and the Prime Minister also, that they cannot and/or will not direct Mr Crow to do their bidding and that it is a relatively autonomous institution that makes its own decisions based on how it sees the economy and what screws need to be tightened and loosened and when. I still feel comfortable sending a letter expressing our disappointment to the Prime Minister that Mr Crow would take this position and that no one, not even a representative from the bank, would be here. I would rather leave it at that and would not feel so comfortable with the recommendation of the previous speaker.

The Chair: Is there a consensus? If I understand it, the motion is I should write a letter expressing our disappointment that they would not come, and request all the information that is --

Mr B. Ward: May we have a clarification of Mrs Sullivan's suggestion of an amendment -- or is it just a suggestion? -- that we invite Michael Wilson?

Mrs Sullivan: We do not have consensus. I mean, we might have consensus, but you have a dissenter.

The Chair: I have one dissenter, or two dissenters.

Mr Kwinter: If you are going to write the letter and say that you are disappointed and "send out the information," I see no problem with that, if that is all you are going to say.

The Chair: Okay, then I will undertake that, and I think we should begin our afternoon presentations.

HALT INCREASING TAXES

The Chair: We have Halt Increasing Taxes; Bill Sadler, chairman, and Frank Cawkell. If you would begin your presentation, please.

Mr Cawkell: Thank you, Mr Chairman. We are the Richmond Hill Halt Increasing Taxes organization. We are located in the town of Richmond Hill, representing a number of ratepayers' associations for 1,300 homes at this time, but growing, within York region and the town of Richmond Hill.

The motion we bring before you today is really that we hope to see budget increases coming out of all levels of government no higher than the level of inflation and that should be a maximum or a ceiling on such increases.

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What we are seeing today and the discomfort we see within the taxpaying groups we represent is really that we need to eliminate programs which are putting a burden on taxpayers. We recognize that we are in a recession, as we all do. We, like everyone in this room, are taxpayers, and we are willing to tighten our belts provided we are given leadership and help to do that by the governments.

We have seen over the last number of years what we feel has been communicated to us as a downloading by the federal government on the provincial and the provincial on to the lower levels of government. That is a concern to us because the buck ends up stopping at the taxpayers. The way the lower levels of government are collecting those tax dollars is effectively through our own house taxes, which, being taxpayers, is really the place where we are most vulnerable. We do not have the options in paying house taxes that we do in paying federal and provincial taxes in terms of deductions and methods of payment.

What we feel we are seeing today are various levels of government effectively downloading, passing the buck, a lot of finger-pointing. Ultimately the taxpayer is still paying the same type of tax dollar and taxes are still going up, they are not going down, so the burden is being shifted. It is being shifted right down to the home owner -- not just to the general taxpayer but to the home owner -- at the municipal level of governments.

What we would like to see and hope to see is a true reduction in total taxes at all levels of government, some of the things that we feel we have seen certainly in businesses today looking at opportunities to eliminate waste, to really not shuffle money when we make a savings -- "Oh good, I've saved some money here, now I can spend it there" -- but effectively to eliminate it. There is nothing wrong with coming in under budget at the end of a year, and a lot under budget if we can. We should be commended on that within government.

A presidential mindset in budgeting: We feel that if every one of us in this room, when we spend any money, but particularly, hopefully, within levels of government, spending money and budgeting money, each dollar should be looked at as if it came out of our personal pocket. We should be asking the question. "Would I spend this money if it was only mine and coming out of my personal budget?" We need that type of responsibility in government today.

Zero-base budgeting approach is a buzzword I am sure a lot of us are familiar with. We see it in business more and more today. The days of saying "What did I spend last year? Great, inflation's 5%; we'll add that on and I'll start there. I've got that much money to start," those days should be over. What we spent last year is immaterial. We should be justifying what we are spending in our budgeting process from a zero base, now justifying and working out every dollar that we are spending. What we spent last year is immaterial. If the program cannot be justified in 1991, although it may have been in 1990, it should not be in the budget. Only with that type of approach can we effectively minimize the increases we are seeing in budgeting.

As we all know, and as we have listed here, these are recessionary times. We, as a group, have started and have been in existence for two years. We have been going to the municipal levels of government as a start, to our own town councillors, regional members of government, councillors, mayors within the York region, to the school boards, realizing that in the lower levels of government the school boards are a large chunk of the house taxpayers' tax dollar, going to them to get their commitment on a similar motion.

We need this type of responsibility from government. We need this leadership from government, and we hope it will be very refreshing that we will all stand up and be counted. Certainly the days of finger-pointing to other levels of government need to stop. We need to see people stand up and say, "I will take on this challenge." We hope that your committee and the provincial government will do so.

Mr Sutherland: First of all, thanks for coming forward. I have a property tax coalition in my riding of Oxford. We talked about the issues. I engaged in a lot of discussion with people in my riding about these issues and how we pay for some of them. What you are saying is, no one likes to pay more taxes. That is granted. We all realize that fact. But there are a lot of realities. There are growing needs out there.

Within this province, and certainly within this country, we have said that there are basic values and things that we think are very important that should be provided. We had the Ministry of Health this morning and we talked about the health care system and other areas, public education. They take up the largest portion of the budget. I guess my sense is that, having these values about how these public systems should be, is it your impression that people want to have those values, want to have those things but may not be willing to pay the price for them? That is not meant to be on an individual basis, but in the sense of a public system and public taxation, which seems to be the acceptable way in the values of funding many of these systems.

Mr Cawkell: Yes. A lot of the public, we feel generally, always ask for more, and we always will; we always have for the last number of years. We feel, given the right understanding as to where that "more" is coming from, that now the public is effectively at a breaking point, where, "Yes, I would love to have another nurse in every hospital, but if that extra nurse is going to cost me X dollars more, I am to a point today in this environment where I can understand where maybe I will have to put that request on hold."

Mr Sutherland: 1 want to come to the education issue. We certainly know about the downloading on to the municipalities, and you talked about provincially mandated programs, and certainly education is the area where it has come. I want to give some credit to the past government. Some of those initiatives have been positive, because the scientific evidence of smaller classrooms, particularly at the lower grades, and things of that nature are very positive.

I am of the opinion that if we are not willing to make the commitment to education at all levels, skills development and retraining right now, then we are not going to have a healthy economy later on. You can hold the tax base, you can hold your taxes on the issue of education and you can try to stop that, but I think you are jeopardizing our future economic wellbeing if you do that too much.

I am just wondering if you would care to comment on that aspect, that in some ways, even if you cut out the waste, education funding overall probably has to be increasing because, while there have been some gains made, this province and this country are far behind the rest of the world in what they are spending on that specific area.

Mr Cawkell: From what I have seen, although I have no figures in front of me, I beg to differ that we are behind other countries in the world. There have been a number of people who have said that we actually, among the seven largest industrialized nations in the world, spend almost the most on education, yet our educational dropout rate in the high schools is one of the highest at 30%. I would argue that we have been throwing money at education for a number of years. Do I see a good bang for my buck? No, I do not.

Yes, we are in a dilemma and we are in a tough position. I do not feel that throwing money at a problem will solve it. I feel that highly motivated and innovative individuals will solve that problem. I feel that you can do a lot more, when properly motivated, with the same amount of money. Money is not the answer. We feel, as an organization, that perhaps in the past we have said money is the answer. I think where Canada is today has shown that maybe it is not, and I would say education is an example of that. Although the provincial government, true, has cut back its funding to education, education funding in total has still gone up over the last number of years. So we have not effectively cut back our money, I do not believe, over the last number of years.

Mr B. Ward: First of all, I would like to thank you for taking the time to come down to express your opinions on behalf of the Richmond Hill citizens.

There are two components I would like you to attempt to address or perhaps give us greater detail on. I think you are opposed to the concept, whether it is federal or provincial, primarily those two, where a program is implemented and is forced on a municipality and yet the proper funding does not flow with it. You would like to see a cessation of that type of policy as far as provincial or federal governments are concerned. Is that correct?

Mr Cawkell: That is correct.

Mr B. Ward: You have dealt with the municipality of Richmond Hill to a degree, I guess. You have made presentations. In the brief that we have, you have "Elimination of programs putting burden on taxpayers." Part of the difficulty of being a politician is that if you have to decide to make a cut, where do you cut? What programs do you cut out? Each program affects an individual or group of individuals. As a politician, you receive a lot of pressure from special-interest groups. Do you have any suggestions that pertain to Richmond Hill that you see could be cut, any specific programs that could be cut? It is easy to talk about it, but do you have any suggestions as far as the provincial government is concerned?

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Mr Cawkell: We do not at this time. Our intent here was not to put forward any detailed programs about what could be cut. Rather than going to governments or school boards, where there are trustees we have elected on our behalf to monitor the expenditures in the school boards, rather than come forward and try to analyse their boards, analyse the government in detail, and come forward with specific suggestions at this time, we have chosen not to do that. We feel we are not the experts. I do not pretend to be an expert in provincial budgeting. I do not pretend to be an expert, and our group is not, in municipal government budgeting.

However, we feel we need to generate an awareness among the governments and the trustees and the school boards that it is time to cut back, it is time to watch the money we are spending and be accountable for that money. Our position with all levels of government we have been with is that we are not averse to looking into areas and comment in on programs that could be cut. Aiding trustees in the school board is an example, where they have come to us and said just that. "What would you cut?"

We said, "Well, give us some figures and we'll go through them together with you and talk about it." But at this time we are not really in a position to say this program or that program should be cut.

Mr B. Ward: So at this time you do not really have any programs that are not serving any purpose in Richmond Hill?

Mr Cawkell: No.

Mr B. Ward: You have not done a great deal in your citizens' organization? You do not have the resources to go into it.

Mr Cawkell: That is correct. I guess we could say that all programs we have initiated serve some benefit, as you pointed out earlier. There will always be an interest group. In any program, someone is taking advantage of it and seeing a benefit from it; at least I hope they would be. Our main point is that when times are in a recession, we need to trim those programs back. It may not be elimination of any given program, it may be just trimming across the board. That is the type of thing we need to be looking at.

Mr Sadler: I would like to answer your questions, Mr Ward and Mr Sutherland. Having gone around to a lot of the home owners and the home owners' associations, we find that the programs are those the minority want. God bless them, they get up and shout and get in touch with the members of Parliament and the local municipalities. The majority sit back and do nothing but complain and hope that maybe Frank and I will carry the ball for them.

However, we found out in the last election that the majority actually did speak out. I think the results are known. We are saying to the elected officials at the boards and at the municipal level and here, bear in mind that there are programs that are not essential and that should be cut. As Frank has so well put it, we have elected you people and we want you to make that decision. If we can help you, then we are here to do so.

One of the things that worried us was a comment made by the ex-director of the school business and finance branch. This was after he was an elected official. He stated that the local property tax was the easiest and best way to finance education, because there were so few complaints from the public. That is the type of thing that worries the hell out of us.

Mr Stockwell: It is very difficult for people such as this HIT group to come in and offer definitive program cuts. It is very difficult to ask an association to come in and do that. That is why we were supposed to be elected. I have always thought that we are supposed to offer them, and if we cannot find them, then the public does not think we are doing a good job and they find people who can find them -- or maybe they do not want to find them at all. Those are the things you find out when a election rolls around.

On the other side of the equation, you can say the people come in looking for money. We don't say to them, "Well, you tell us where we should tax to get the money to give you." Nobody ever asks that question. We just try and find the money somewhere. If we cannot find it, we cannot find it; if we can, we can. But no one puts them on the spot, saying: "Should we increase the price of beer or tobacco? You tell us where to get the money."

It is not really a fair question to ask associations. They are doing this in their spare time, this is literally a job they are doing for free -- unlike ourselves, of course.

The other point I would like to make with respect to HIT, maybe not so much a question as a comment, is that your definition of a priority and government's definition of a priority are different. To people in the private sector who are in business, if something is a priority then it gets money and certain areas do not get money. That is how you define your priorities. The trouble with government is: "We have 28 priorities. Everybody gets more money." I think that is what the HIT program in Etobicoke is in fact suggesting, and the downloading is a long, debatable argument that will have more finger-pointing every time you enter into the discussion.

I would like to make a point with respect to where you make your cuts. I do not know if you even need to cut; maybe it is simply hold the line. A perfect example, though, is that the Minister of Labour today announced a program for new job training. Here is the Minister of Labour announcing new job training programs. What the heck do we have a Skills Development ministry for? We are spending $400 million on a Skills Development ministry and we have the Minister of Labour announcing new skills development programs. There is a bit of redundancy there, duplication.

There are some examples that could be taken by this HIT group and given to you, but I do not really think it is fair to say to every group that comes in here, if they are asking you to hold the line on taxes, "Where would you find the money?" I think we are supposed to be elected to do that.

Mr Kwinter: One of the most common comments I get, particularly out in the business community, is, "If you guys would only run the government the way we run our business, everything would be great." Most businessmen have about three obligations. One is to their bank manager, one is to their wife and one is to their shareholders. If it is a matter of not being able to afford to do it, you just cut it out and that is it. It does not matter what the repercussions are as long as those three particular groups are happy.

In government it is not that easy. We are accountable to over nine million shareholders, and everyone thinks their priority is as important or more important than everyone else's. The genius of government is how you mobilize the resources that are available, both natural resources and economic resources, all of the things that are there, to try to do the most good for the most people. That is very difficult. It is very difficult, considering that we are in a situation where the rules keep changing.

At one time we lived in a very comfortable little niche where what we did in Ontario affected what happened in Ontario, with very little outside pressure. We are now into a global economy. To give you an example: R and D. If you talk to anybody who is looking at our competitiveness, R and D is the critical factor and unless we invest more in R and D we are going to fall by the wayside, we are not going to be as competitive, our standard of living is going to deteriorate and we have to devote money to it.

At present, the United States is the highest spender on R and D in the world, at about 3% of gross domestic product. Japan is second at 2.8%. Canada is at 1.3%. In Ontario we are a little better, at 1.7%. You can imagine where Canada would be without the Ontario component, because 60% of all the R and D is done in Ontario.

We are woefully underspending and it is going to impact on us. Unless we get that spending level up, we are going to find that we are less and less competitive. Someone recently referred to Canada as a Third World country with illusions of grandeur. We are trying to maintain a standard of living that is comparable to the leading industrial and economic jurisdictions in the world and saying, "Let's do it, but let's not spend the money that is required to do it."

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I agree that anybody can look at government and say, "That program is getting money and it is unwarranted, and we should put more money somewhere else," but I think it is a simplistic sort of solution to say there should not be any more spending because it is impacting on the taxpayer. Under our system, anything we do impacts on the taxpayer. The role of government, as I say, is to get the biggest bang for the buck and to be accountable to those taxpayers.

You are presenting a point of view and I appreciate it, but I can tell you there will be l0 other groups that will come in and present another point of view in saying, "I want more of this," and, "I want a share in this thing. There is an élite that gets the major benefits of all of the things that are happening and we are shut out," for whatever reason, whether it is cultural, racial or economic. They want a piece of the pie. That is the problem we have.

As I say, I am totally sympathetic with the basic concept of saying there should be value for money. But I really think it is a little simplistic to say: "Hold your expenditures down. Go back to zero-base budgeting. The increase should only be the rate of inflation." If you do that, you are really relegating us to a non-competitive situation, because there are intangibles. If you are going to attract investment, it is more than just monetary. It is quality of life, it is the environment, it is all of these things, and there is a cost. You have to decide how much you can pay and how you allocate the sharing of that payment. That, as I say, is the genius of government or the folly of government -- whatever.

Mr Cawkell: If I may respond to that, I think one point you made is very valid. The playing field we are on is changing all the time. We cannot agree more. Therefore, the need every year is to re-evaluate where the money is best spent, the best bang for the buck, as you said. R and D is one area, there is no question. It should be an area of focus for the government. It may not have been and probably was not five years ago.

What we are hoping is that we do not see a need to go beyond inflation, as long as we are letting go of what were yesterday's focuses. Are we letting go of the things that 5, 10 years ago were important, be they increases in social programs, where we increase spending. Are we letting go of those and then changing our focus to make sure we are competitive? If we see R and D spending being that area, so be it, it takes a priority. Are we letting go of money we spent in the past? We understand it is not easy. Being in government is not something that is very easy. At the other end, though, we really have to be able to let go of some areas to satisfy the taxpayers the best we can. When we cannot or when it may be in question, hopefully we will educate those taxpayers.

I guess one of the things that even a lot of members of our group two years ago did not understand was how the money went, drawing the connection to, "Well, we wanted this program; therefore, I can't have this," or "therefore my taxes go up." Sometimes that connection was not always being made. If someone is coming in for money for a program, it is very simplistic to say, "If you get that, where would you get it from?" but at the other end, it may help to facilitate an educational process within the public.

Yes, we need a number of the things you indicated, social programs and what not, to draw investment, but at the other end, as you pointed out, potentially in Ontario and in Canada we are running on a standard of life that we cannot support, and we are supporting it with government money. If we are going to be competitive in the long run, we have to refocus where we are putting that money.

As we said earlier, throwing money at everything is not the way to do it. The zero-base approach is simply: What is most important? What is the best bang for our buck? How are we going to be competitive? Cutting back on the other end and then educating the people so that they understand, instead of selling ourselves as a government and saying, "Look at all the great things we are doing" -- please do not be afraid to say, "We have to cut back here and we are doing some bad things, but here is why."

Mr Sadler: The point on R and D is very valid. I am retired and I love Ontario and plan to live here for the rest of my life. I have grandchildren and I have daughters and sons in Ontario, so I want to see us become very competitive. But if we put the money there then we have to find that someplace where we spent it before is not necessary.

We met with our member of Parliament in York and the comment was: "There is waste in any system. One thing I know about politicians is that ultimately they get their sense of authority by spending money." That is really, I guess, what the message today is. We do not mean to say that all the gentlemen around here feel the same way, but it is a fact.

I worked for a company. I was very selfish. I wanted to get as much as I could until the president of the company said -- as you said -- "I have to answer to shareholders." They might have been a lot less than the government has to answer to, but nevertheless he admitted: "There is waste in our company and we have to get rid of it. I won't tell the shareholders that. I only tell them what I want to tell them, but I want to make damned sure when you put your budget together that you take that waste out of the system so I can give you a better increase in your salary and those working on your behalf."

Mrs Sullivan: There has been ample and interesting testimony before this committee relating to recommended actions by the government in dealing with the downturn in the economy we are facing. The recommendations from the economists have been that there be stimulatory spending, both in capital areas and in social areas, including retraining of workers and such areas as Mr Kwinter has addressed so eloquently, research and development.

Given the acceptance of those recommendations by government, there are two places where money can come from to pay for that. One is through new taxes; the other is through new debt. I would be interested in hearing your views on increasing the provincial debt.

Mr Cawkell: We would not be in favour of increasing the provincial debt. As we all know around this room, it is one of the reasons we, as a country, are in trouble today. I would, however, turn back, as I have with Mr Kwinter, that spending money on R and D and spending money on job retraining is the way we want to go. We do not want to be spending money supporting companies that cannot carry their load, and we are doing that at the other end of the spectrum. Such are the programs that we need to let go of.

Again, we are not here to say let's not spend money. We are not saying that at all. We are saying we had a large budget last year and we are looking for a 4% to 5% increase this year, thank you very much. If we need to go above that, then we really need to go back and see where we spend the money.

We can add R and D to the budget and increase the spending there. I would be all in favour of that. But, at the other end our message is that something else will have to go. The public needs to understand and needs to agree, as Mr Kwinter did so eloquently point out, that without this spending and this focus on R and D, our children will not have an effective country to live in.

Mrs Sullivan: I just want to clarify this. You seem to be leading us to the position that your view is that social spending should be cut. Is that your view?

Mr Cawkell: No. We are not cutting any given programs but our view is that we need to evaluate all the programs we do spend on, whether it be social spending, R and D, whether it be support for companies -- we do a lot of work in the government where we support companies that are in trouble and lend them money for programs. There are a lot of things. We have our fingers in a lot of pies. What we would like to see, as taxpayers, is that we effectively evaluate those pies and then go back and ask where our money is best spent.

Social programs may be at the top of the list. When all is said and done, our nine million shareholders may say, "We need our social programs." So be it. Maybe we do not get the R and D spending. But if we do not get the R and D spending, I would hope our government would explain to the taxpayers without such spending the type of state our country may be in in the long term. the repercussions; that we make that trade-off and educate the people, to go that way. Potentially, with that understanding, with that knowledge, the taxpayers may very well say, "Well, then, turn back the social programs a little bit and spend more money on R and D."

I do not have that answer, but that is the type of decision-making process that we hoped the government would take.

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Mr Sadler: Mrs Sullivan, I think what we are really saying is that it is priorities. You are the elected officials. We assume and we feel confident that you are the right people to make the decision as to where the priorities are and where the money should be spent. Going into debt, I am against it, personally. I see it in our own area up there. People are out of jobs. They are going bankrupt. To go further into debt and put a higher mortgage on their home, is that the answer? You have got to face your problem. You have to recognize that sooner or later you have to pay back that dollar.

Some of you were just having the motion, when we first came in, about the Canadian dollar and the rate of interest, which affects not only government, but affects us, people who have mortgages, people who borrowed funds. There are more and more individuals going bankrupt and losing their homes. That is our priority in Ontario. We do not want to see that. We have seen a small town, Blenheim, that had a very effective tax revolt and said: "No more. We don't want it any more." They were successful.

I do not think that people are actually against the GST if those funds were being used to reduce the debt. As it has been said in the paper, you know and we know that if the money gets into their hands, it is going to go to other things. That was not the idea of the GST, and I am afraid that is what is going to happen. Really the message is, "We are not in favour of debt," if that answers your questions, and the reasons behind it.

Mr Christopherson: I had a few questions, but the time is going on. Just a very brief comment, Mr Chair, and that is, with a great deal of respect, that I would suggest to the presenters -- and I do thank you for your position -- I think that role needs to be played, that continuous pressure needs to be put on government, regardless of the party in power, to be watching the tax dollar. That is basically what this is all about, relative to the budget.

But I would say clearly to the submitters that there was an opportunity very recently, in the general election, to adopt the philosophy that said bottom line first, that the bottom line takes precedence over everything else and that from the bottom line you then deduct where you need to. I believe that the public spoke very clearly and it rejected what is basically, to many of us, a simplistic approach that does not reflect the needs of a modern society such as ours. If you need to see that example in action, stay and listen to the next group that I have heard first hand and will hear again and will listen to very attentively, and listen to the kinds of pressures that are there. That is repeated many times over, and very legitimately, by many groups.

The other thing is -- and this is the dichotomy -- that most people find themselves at one point or another as being on both sides of the fence. All of us rightfully say taxes are too high. We as government should never lose sight of that feeling among the public. But by the same token, there are very few people who at some point do not say, "There should be a law about that," or, "There ought to be a protection," or if your child needs something, we do not say: "That should be provided. Why doesn't the government provide that? There is a real need for that." We do that so many times over and over that I think when you are sitting here and you see all that rushing at you, you begin to understand why the public says, "I reject the idea of bottom line first, but I am not going to let you forget that taxes and the impact they are having on my lifestyle is important." That is why your role is very important.

By way of a suggestion, and it is offered with the greatest amount of respect, I do think that if you want to be very effective -- and I think you are very serious. Mr Stockwell makes the point that you are here on your own time. That says a lot about your commitment to this issue. The idea of coming forward with some specifics, although that may not be your role, is perhaps how you can be most effective, because again, I hearken back, the idea of bottom line first was rejected by the public. Lord knows that has not been the position of the NDP, and we found ourselves in a majority position at the end of 6 September. So I think that the public has spoken there. What it wants from us now over the next four to five years is good government, to make those decisions that Mr Ward talked about, to do that balancing, that juggling. That is where we need both the carrot and the stick as a government so that we are going in the right direction and the public speaks loudly and effectively when we are going down the wrong road.

I do thank you very much for coming. I have enjoyed your presentation. I hope you continue. You have got an important role to play in the development of this budget and others to come.

The Chair: On behalf of the committee, I would like to thank you for your presentation and your time.

ONTARIO HOSPITAL ASSOCIATION

The Chair: Our next presentation is the Ontario Hospital Association: Brian Birkness, chairman, and Gord Cunningham, president. Welcome.

Mr Birkness: Mr Chairman, thank you for allowing us the opportunity to make this presentation to you today. I would like to introduce myself. I am Brian Birkness. I am a trustee at Scarborough General Hospital and a volunteer, and the volunteer chairman of the volunteer board of the Ontario Hospital Association. With me is Gordon Cunningham, president of the Ontario Hospital Association.

On behalf of Ontario's 224 public hospitals, I would like to thank the committee for inviting the OHA to appear before it today. This is OHA's fifth term as a participant in this budget consultation hearing, and we find it a very useful process.

I would be pleased to explain in detail OHA's request for a 13.2% increase in operating funding for the next fiscal year, but I think that is well covered in our submission. We will certainly be prepared to answer questions on that. I feel it would be more appropriate and useful, in order to assist this committee in its work, if I indicated to you the crucial issues that face Ontario hospitals. Following that, I would be happy to answer questions.

Hospitals are almost solely dependent on government funding. Just over 80% of hospital operating funds come from the government. While municipalities get only 35% and school boards get 45% of their funds from the provincial government, they have the ability to draw on local taxes. We do not have anywhere else to turn to make up our funding shortfalls.

The graph at the end of our brief shows that government funding levels have not kept pace with inflation's impact on Ontario's hospitals. Over the past 10 years, there has been a continuous year-to-year shortfall in our funding. The hospitals' share of the health care spending pie has dropped a full 7% over the past 10 years while other areas have increased their share, such as payments to physicians and the Ontario drug benefit program.

Hospitals have little control over most of their operating costs. In addition, they have large costs imposed on them over and above inflation. Many of the increases are due to government-imposed programs, such as pay equity, as yet unresolved for many hospital groups, the employers' health tax and arbitrated wage settlements. As each of you well knows, in 1968 the province of Ontario introduced the Hospital Labour Disputes Arbitration Act, which requires compulsory arbitration of collective bargaining disputes by an independent third party and prohibits strikes or lockouts by hospital employees.

If I might direct your attention to page 8 of our brief, you can see at the bottom of that page the broad categories of typical hospital operating costs and the percentage accounted for by each of those costs. As you can quickly see, approximately 75% of hospital costs are related to salaries. When we speak about opening or closing hospital beds, what we are referring to are the staff salaries required to serve the patients who use that bed. Hospital budgets, because of this, are very sensitive to increased costs brought about by the result of collective bargaining. This is simply a fact. When you have close to 150,000 people working in the hospital sector, they are going to be very sensitive to adjustments in wages.

A graphic example of this is also noted on page 8 of the brief. For employees represented by the Ontario Nurses' Association, ONA, and the Ontario Public Service Employees Union, OPSEU, we have calculated that every 1% increase in compensation levels above that currently prevailing in the hospital sector and as factored into our model would result in an additional cost of $29.25 million. I would like to repeat that. Every 1% increase will result in an additional cost of $29.25 million.

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As well, changes in government legislation and regulations, which increase the cost of hospital operations, have a significant impact on hospital budgets which are already hard pressed by compensation packages and other inflationary factors.

On the subject of alternative care, it has often been suggested that the best way to reduce hospital costs in the long term is to move towards a home-based, non-institutional care program. Let me say once again for the record that we agree conceptually with this approach. It is, however, a notion that sometimes is too easily embraced as a cure-all remedy. To us it is something that is very complicated, involving both massive attitudinal changes among patients and their families, doctors, nurses, hospitals and local communities.

It must be realized by all involved there must be a planned, co-ordinated approach to the kind of deinstitutionalization and decentralization envisioned. As well, in the transition to any such new system, there cannot be allowed to develop any patient-service gap. Without a proper infrastructure in place we could well have 224 different plans, approaches and standards of health care in Ontario. This is where government's role as a co-ordinating and funding body is so crucial if we are to develop an effective and workable system of community care.

At this time, alternative care is not in place. No one knows what the demand is for community services. How much will they cost? How effective will they be? They may very well not reduce health-delivery costs but rather increase them. Hospitals are now playing a key role in the provision of some of these services, such as social services, health promotion, illness prevention, a program of hospitals in the home, women's health centres and other outreach programs. Community hospitals have been very much involved in developing outreach programs and programs of hospitals in the home.

At this time, the OHA is concerned by the lack of overall provincial planning. We suggest that, before the decision is made to commit hundreds of millions of dollars to an alternative system, the government consider the community hospital as key to the delivery of quality, cost-effective, community-based health-care services.

Finally, as I said, hospitals are central to the life of any community. You need only look or you need only think of the 17 or so hospitals that the members of this committee represent and you will realize just how vital they are to your local communities and to your ridings, not just as health providers but as employers and as educators. Local communities are heavily involved as users, suppliers and hospital volunteers. The hospital is central to most communities; I would go so far as to say to all communities. As you look at the needed institutions in your communities, you need your churches, you need your places of education and you need your hospitals.

I hope we have been able to give you some indication of the importance we attach to being a governmental funding priority and the fiscal problems which we face. Our employees expect to be paid as they deserve, government expects us not to incur deficits and the public expects a first-class accessible community hospital system in this province. We hope to satisfy all of these desires. I hope that with your help we can continue to meet those expectations. Thank you very much.

The Chair: I have Mr Phillips first. He is getting on the list because he does not like to be left off.

Mr Phillips: I missed out on a couple yesterday, so I thought I would get my hand up early. First, I congratulate you, Brian, and the volunteers at the Ontario Hospital Association. If you do not mind my telling a little personal story, I was chairman of Scarborough General Hospital and I felt that Scarborough General should play a larger role in the Ontario Hospital Association, so I suggested to Brian that maybe he should go down and just do a little bit. Now look where you are. You must spend half your time on this job, and I think all of us do appreciate the work the volunteers do on behalf of hospitals.

Mr Birkness: And I hold you responsible.

Mr Phillips: And he is a different political stripe, just so you know he is not a -- I will not say what, but just different.

Mr Birkness: I changed it a month or so ago.

Mr Phillips: A small, little investor in a New Democratic Party. Things have changed.

Mr Christopherson: Another instant convert.

Mr Phillips: I will get to my question, but I do think it was a thoughtful brief, and your recommendation to us to think carefully about the implementation of community care is a good one, because I think most people embrace it very much, your suggestion of making sure we know where we are going.

My question really is around something that we all know is just going to happen within the next two months. It is very difficult to talk about it because it is collective bargaining. But the reality is that 40% of your budget, I think, is nurses' salaries. I am not being partisan here, but the Premier did go to the Ontario Nurses' Association convention well after the election, well after the finances were in place, and essentially made some very significant commitments to the nurses in terms of salaries. That, in my judgement, will drive your budget, and that is just reality and that is what is expected.

I guess I am just looking for some help from the OHA, and I realize it is difficult in a public forum to provide that, but I know that the pay equity settlement that was reached recently with Sick Kids is I guess $8,000 or $9,000 per nurse. I think there are 50,000 nurses in the hospitals, if I am not mistaken. Can you help us out at all in terms of what we should be, or are we just going to have to let it unfold? Because I just think it is inevitable that there are going to be some tough times over the next three months, understandably, in the negotiations between the hospital association, the government and the nurses. I do not know whether you can be any more helpful than you have been in your brief in terms of the sorts of moneys that we should be anticipating to put into the hospital budget.

Mr Birkness: Gerry, as you know, the brief very clearly sets out what the impact is going to be on salaries if we increase beyond the amount that has been provided for in our calculations, which you are all familiar with and which we have made no bones about, that we have allowed for an 8% increase in these calculations.

The Premier has said that nurses are entitled to reasonable increases. I guess in this economy the obvious question is, what is reasonable? I understand a lot of people are holding the line at -- we talk about a zero base, and it might be reasonable not to have your salary cut, I do not know, and certainly I guess that is the issue that the negotiators are going to have to face. Hopefully it can be settled before it reaches arbitration. If it has to go to arbitration, I would believe that the arbitrators are also going to have to deal with that and should be aware of the consequences of these adjustments.

Mr Phillips: I just think, realistically, we should all recognize that either now or three months from now or something like that -- because, as you have pointed out, 75% of your budgets are through negotiated settlements --

Mr Birkness: If I could add to that, Gerry, a concern I have is that, as you know, we at the individual hospitals operate on a global budget. Our requested budget is what we hope we would receive from the province, and if we receive that and if we find that the salary increases go beyond that provided and if those are not additionally funded to the hospitals, then once again we find ourselves behind in our funding and in our budgets. We will not be able to meet our budgets.

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Mr Christopherson: It is a pleasure again to meet with and hear from you, gentlemen. The only question I want to ask, because I did have the opportunity to ask some questions and listen to some more in-depth discussions when we were with the Treasurer, is that on the last page of your presentation, the second paragraph in, it talks about alternative care, community services. Let me ask, first, are we specifically talking about home care there? By and large, is it what you are talking about; the ability of home care to replace institutional care? Is that the issue there?

Could I ask you then, because I hear conflicting information -- on the one hand, there was a general thinking for an awfully long time, relatively unchallenged, that in-the-home care would clearly be cheaper than institutional care, period, full stop. I have now, over the last year or so, begun to hear some people suggesting that this is really not the case and that if you start taking a look at some of the specific services and talk about fair wages for those individuals and the appropriate kinds of comprehensive care that may be needed, we may indeed be talking about a cost that is equal to and may be, as you suggest, even greater. I am not trying to set up for any particular party position. I am sincerely asking you what your thinking is on that particular issue of cost.

Mr Birkness: I do not believe that at this point in time, anybody has actually gone through the calculations to determine what those real costs will be, but as you consider, you have answered your own question. In fact, when you consider all the factors that go into delivering home care service, you can see that as you bring professionals into the home, you have to move them from location to location and there is going to be a substantial cost in doing that. I suppose that is one of the reasons why doctors stopped making house calls. There certainly is a substantial factor. Until we really know what the real cost is, it is going to be very difficult to measure that.

At the same time as I say that, the hospitals have recognized that many patients are better off in their homes than they are being in an institution. Having caring, concerned people around you is very important to an ill person. I think every one of us knows that if we have to be taken of when we are ill, it is always nice to have your spouse do that for you rather than being in an institution. People would rather be at home, but there will be a cost to do that and I am suggesting that if that is to be done, the people who should be doing that are the community hospitals because they are well positioned to provide that outreach program and outreach service. A lot of that is already under way.

Mr Christopherson: To follow up -- let me make a note so I do not forget -- I outlined some of the costs and that is one side of the argument. Of course, the other side very clearly is that you point to the dollar figure for a one-day stay in a hospital. What would be a rule-of-thumb figure for a stay in a hospital? Would it be $300 plus, $400 a day?

Mr Birkness: Or more.

Mr Christopherson: You have to talk of an awful lot of professional services and support mechanisms over the course of a month or over the course of a week for an individual before you would total the equivalent of $400 a day. That is an awful lot of money.

Mr Birkness: Depending upon the acuity of the patient, of course.

Mr Christopherson: Yes, and the level of care that is required. I only ask the question. Again to be consistent with the positions I was arguing earlier, it is not that the bottom line is going to drive this. The desire to have individuals stay in their homes and the ability to stay in their homes is a social goal of this province. I think most people have recognized that and I think that is a motherhood issue.

The question is, if it does save money, clearly, and that is by and large an accepted fact, then we should be rushing towards it much more quickly than we already are, which of course is the opposite of what you are suggesting. If it is break even, much of that same argument still holds. If there is an increased cost, then there is maybe more weight to your argument that we should move perhaps a little more slowly, to ensure that it is as efficient a system as possible.

I suggest to you that both sides of the argument, including the ministry people, are going to have to start putting more dollars on this issue, because especially in a time of recession that will have a significant impact on how quickly things are brought on stream.

Let me ask you one question. With the hospital providing, would you not agree that this is kind of running contrary to conventional thinking right now? Even that the institution would provide the community care runs contrary to the thinking that you want to devolve more and more to community care, community planning. community co-ordination and less involvement by the institution rather than even a maintaining of its current profile.

There is a lot of thinking that the institutional aspect is part of the problem and that it is far too bureaucratized and is not sensitive enough to the community. I know you could argue that point and you would not agree with it, but I would ask you, how would you suggest this government would respond to that position you are putting forward in light of the fact that it does run contrary to a lot of the current community thinking that goes hand in hand with this staying in the home providing support services concept?

Mr Birkness: I think the attitudinal changes we spoke about in our brief are being developed among medical staff, among nurses and they recognize the need to get a lot of the care out into the community, into the homes. As to the fact that the very people who should be providing those services are in the community hospitals, I think the structure has to be established to encourage the hospitals to develop the hospital and the home profile and to move that into the community, and possibly through a funding structure. That is the way that will be encouraged. You might want to add something to that, Gordon.

Mr Cunningham: This necessarily gets into two or three different subjects. First of all, the hospitals collectively and totally believe that we want as little institutionalization as possible. We want people in their own homes. The hospitals of Ontario in particular have shown leadership in Canada to have outpatient surgery in a great number of instances and have really concentrated on the fact that it is part of our duty to keep people in their own homes by keeping them mobile by knee replacements and knee operations and hip replacements and things that allow people to go home.

If we are talking about a fairly healthy individual who is mobile and may be able to work, but needs a therapy, it certainly is ideal if that person can go to the hospital daily or weekly or whenever he is needed for his therapy. I think it is absurd to believe that we should provide therapy in the home for those who are relatively mobile and perhaps being rehabilitated.

In the hospital, we must build a facility for the community, for outpatient surgery, for outpatient diagnostic things and for outpatient therapy, but one of the dilemmas we face is the aging of the population. We are getting more frail and we need multiple care. Certainly those who are getting elderly and frail we do not, as institutions, want housed in institutions. Ideally we want everybody to have the best life and if possible that should be in his own home. Then the question comes, how do we build that infrastructure to serve those people? Very often they need several therapies, not one.

We then come to the question, what is the most economic way? Mr Birkness is right that the literature does not yet show that it is any cheaper to do it in the community, so we have the question of economics and we have the question that the hospital is indeed a part of the community. For some reason we have slipped into the bad habit of talking about community services as though they were something different than hospital services. Hospitals are an integral basic part of every community where they exist. So it becomes a question of whether the hospital should be providing the multiple care for the frail who need it, or should we be setting up some other kind of infrastructure? That is the difficult part that you face in your funding and it is the difficult part we face in being part of the community.

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Mr Sutherland: We had the Minister of Health and the Deputy Minister of Health this morning and they were talking about issues that we need a health management system and that this in itself has not really occurred. I want to focus in on a couple of areas. Perhaps you could give me your assessment of the situation.

I have three hospitals in my riding and no one in my riding is more than 25 miles away at the most from any of those three facilities. You mentioned the community aspect of it. All three of those hospitals have had expansions within the last five years. That is a great thing for a community. Everyone loves to be a part of that.

I am wondering, from your assessment, is it a question that those hospitals are providing -- obviously they all have to provide similar basic services, but what about different services? For example, are there services one hospital could provide for the riding and another hospital could provide a different one, so people in the one community may have to drive to the other one to get that specific basic test, obviously not emergency-type service?

I have also talked to a few people who have been working in hospitals and they left me with a sense -- this is meant as no disrespect to anyone who works on a hospital board, because I know it is not an easy challenge -- that hospitals felt like they were in competition with their neighbouring hospitals in terms of they want to have their hospital doing the things and getting a larger share of the marketplace.

That type of philosophy or thinking towards health care is rather disturbing, to me anyway, in terms of we are all there and we all should have the same goal of, how do we service the people most effectively? Yet there seems to be a sense that: "I am in competition. If I can get the health council to approve that, that's great for us and our hospital." Would you care to comment?

Mr Birkness: I would be glad to. You are absolutely right. Rationalization of services within communities is very much uppermost in everyone's minds involved in hospital services. We in Scarborough, as you know, Gerry -- you were very much involved in the thrust of this, getting the Scarborough co-ordinating committee working to deal with rationalization of services.

Mr Phillips: That is right.

Mr Birkness: Some areas have done this very well. Hamilton has done an excellent job of creating a rationalization of services. Each community needs to have a co-ordinating committee of those hospitals. In your instance, the three hospitals that serve your community should be sitting down on a regular basis to discuss certainly any new services that are to be brought in, who should provide those services and how they would best be delivered.

Mr Sutherland: Can you give me a sense of how province-wide that is? Is that going on right now from your assessment?

Mr Birkness: To my best knowledge I believe there is a lot more of this going on. I do not know that we have any specific data, do we?

Mr Cunningham: I would respond to this by touching on one part of the subject. We are on record with the Ministry of Health, with the previous minister, and again speaking briefly to the new ministers with the bureaucracy as saying that we the association believe that we have not had adequate planning at the provincial level for an overall plan.

We applaud what the Premier's Council has said in the last two or three years, where it has come out with statements that we should be looking at less institutionalization, that we should be doing many things, that we should be setting health goals. What we have said to the Ministry of Health is that we believe the institutions are well managed, delivering good care, doing many good things, but that there is the lack of an overall provincial plan. We have had, at least from the bureaucracy, some agreement and some expectation that the association, with the ministry and the district health councils, collectively could do a better job of provincial planning, and we are ready to do our part.

Mr Birkness: On the question of competition among hospitals, we have been doing a lot of work at the OHA in providing information to trustees. education to trustees, to get them to understand that there is more to health care and hospital care than just their own hospitals, and a real need to understand what is happening in their community. As to this feeling of competition among hospitals, I think you will find less of that today than you might have found a few years ago. I know even in our own hospital board that seems to be disappearing and we are thinking of ourselves more as a community and working together.

Mr B. Ward: I think you touched on my question to some degree. We had a presentation from the Ontario Public Health Association which in essence recommended that our government freeze funding to the institutional type, which is hospitals, and that the greater concentration of dollars be put into the community-based health system or health care. The feeling I get is that may be a proper direction to head into, but that we are not really sure yet, and that until we are sure, let's continue to fund the hospital system so that we have the best institutions and health care available from that aspect, and begin the exploration of community-based health so that we can have a handle on what are the long-term costs, the long-term standards.

It is not a concept that you reject; it is just that you feel it is perhaps a little bit early for that type of funding where we freeze the hospital association and its allocation. You do not disagree with that concept; it is just that it is premature. Is that a fair statement?

Mr Birkness: Yes, it is a reasonably correct statement. What I am saying is that basically we agree that with the idea to move as much health care as possible into the community, into the homes, to get people into proper settings for the kind of care they need, the other side of that coin is that we are asking, what is the point of developing another group, another organization, and funding that to provide this service when your own community hospitals are in a position to develop that and to work together with the ministry to develop that kind of service?

We agree that it should be done. It is just the methodology which is the thing we challenge. We also are saying: "Let's not rush into it blindly. Let's be cautious and step carefully into this whole idea and make sure that what we are doing is providing a better, well-thought-out service, and not just" -- as the speaker before us suggested -- "throw money at something that may not give you anything more effective.

Mr B. Ward: It is the position of the OHA, the upper echelon, that hospitals should work together in a co-operative fashion so that there is no duplication of services, so that we are getting the most efficient use of our tax dollars when it comes to the health care that is utilized through the hospital system. Are you fairly confident that philosophy has filtered down to the hospitals? To be honest, Brantford has two hospitals, Brant county has one, and the perception I had -- I was on the Brantford General Hospital board for a year -- was that those turf wars were still continuing to a degree. I am just wondering what avenues the OHA has taken to ensure that this concept of mutual co-operation is filtering down to the administrators and to the various boards that run the hospitals. Can you comment on that.

Mr Birkness: First of all, there has been a lot of education about the delivery of health care services. As I spoke about, we have developed five videos for trustees, teaching them what their responsibilities are in terms of the delivery of services within the hospital and emphasizing these very things. There is no longer any room, if there ever was, for waste within hospitals. The predecessor government made that very clear to hospitals, that where there was any potential waste, any fat within the organizations, that was going to be removed. It was simply removed by reducing their funding, as you well know.

The hospitals have had to operate their businesses -- hospitals are a business; I should emphasize that; they may be a not-for-profit business, but they are very much a business -- as efficiently as they possibly can. Any waste that was in hospitals, any fat that was in their budgets, has been removed. Those things have disappeared. Hospitals are operating efficiently and they have to operate smarter, and the only way they can operate more efficiently and smarter is to cooperate with one another. So I think you will find there is a great deal more co-operation among hospitals, there is a better understanding on the part of trustees and there is a better understanding by hospital administrators of what needs to be done.

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Mr Sterling: I was looking at page 4 of the appendix to your brief. You show 49,832 hospital beds in Ontario. How many of those are in chronic care institutions, or are they all acute care?

Mr Cunningham: Twelve thousand is the closest answer we have.

Mr Sterling: So if we take 12,000 off that, we end up with about 37,000 or 38,000 acute care hospital beds. Of those 37,000 or 38,000, how many actually have chronic care patients in them?

Mr Birkness: Do we have any statistics?

Mr Cunningham: Of that 12,000, approximately 6,000 are in what we would call freestanding chronic care hospitals. Those are about 20 institutions in this province which are long-term care, chronic hospitals. The other approximately 6,000 would be in chronic care wings of acute care hospitals. It is pretty much an accepted fact in Canada and in most western jurisdictions that if we did an instant snapshot at any one moment, if we looked at who is in what bed, we sometimes find people in inappropriate beds. That is, a frail person may have entered an acute care hospital for an acute episode and should be there; however because there is no immediate availability of another chronic bed and they are unable to be looked after at home, they are in the wrong place at the wrong time. They are not getting the rehabilitation or the best level of chronic care because they are in the inappropriate bed.

Quebec did a study only two years ago and said that upward of 20% of its patients were in the wrong bed at the wrong time. They questioned us closely here in Ontario, what was our figure. We did not have up-to-date figures, but it is generally accepted wisdom that 10% to 15% of patients may be in the wrong and inappropriate beds. It is unfortunate.

I would say that hospitals have done their best to address that problem by having people who are specifically working within the community to work at placement coordination to get people in the right beds. I think it is better today than it was five years ago, but I would still have to take an educated guess and say that upwards of 10% are probably in the wrong bed at any time.

Mr Sterling: The number of acute care beds seems to be a constant problem, particularly in terms of people wanting to get elective surgery, etc. Can you provide me with an educated guess of the number of acute care beds that have been available for the public in Ontario for the past five or l0 years? Do you have any statistics like that?

Mr Birkness: Just a clarification of the question. You are trying to determine how many beds have been closed over the past five years?

Mr Sterling: I am having a hard time getting a handle on what the problem is in terms of acute care beds in hospitals.

Mr Birkness: Why people cannot get beds when they require them?

Mr Sterling: That is right. The population is increasing. In the area I represent it is increasing rapidly, but the number of acute care beds is not increasing rapidly.

Mr Cunningham: I can only give a partial answer. I can start by talking about this matter of bed closures. The hospitals, in my view, use good management and attempt universally to use the dollars to the best advantage. This is buttressed by the voluntary boards and the modern administration we have.

There are times when it is valuable to close beds. More particularly, in our Canadian way of life it is quite true that in the summertime most of us want vacation if we can have it, and there are many people who do not want elective surgery in the summer. If a hospital can truly find a time when it can close some of its operating rooms and close certain wings, it makes good sense; if medical staff want to take a vacation. That is good management. Certainly the same thing happens at Christmastime. Over the festive season it is absolutely true that as many people want to be home as possible. It is good management in saving dollars and closing beds, so we do have normal, good management practice of closing beds at some times.

Where we start to get confused is this: Sometimes, because of economic reasons, we find that hospitals close a wing, say, at Christmas or in the summer, and because their budget is short they try to keep that wing closed as long as they can. We get a great deal of fluctuation. The Ontario Hospital Association is a voluntary association. We have made a determination that the beds fluctuate so much that it is a senseless game for us to keep track of how many are open or closed at any one moment. That is why we tend to waffle a little on our figures.

The Hospital Council of Metropolitan Toronto, by contrast, has the large Metro population to care for, and it does have co-ordination of the beds within Metro and does keep track of how many beds are closing at any one moment. We get varying figures, but the Metro figures have shown that due to economic reasons sometimes it runs about 3,000 beds closed within Metro at any one time. Some of that is good, because it is responding to the seasonal fluctuation; some of it is bad because they have had to close for economic reasons, and that backs up the surgery.

I cannot give you a very fixed answer, but we do try to translate, we try to ask our members what the lack of funding does to them. To the best of our knowledge, last year, the year which ended 31 March 1990, 800 beds seemed to have been closed permanently and taken out of the system.

Mr Sterling: Again looking at your figures, you show the average inpatients is 43,600 patients a day. If I take that as a fraction of the number of beds you have in the province, including chronic care beds, you are pressing 90%. It seems to me that while we hear all these arguments for deinstitutionalization, clinics, etc, our hospitals have tremendous pressure on them for acute care patients. The last government in 1986, I believe, went out and made all kinds of promises about a whole bunch of new acute care beds that were going to be built in this province and then reneged on that promise, I believe on the basis that these clinics were going to draw away the need for acute care. I just do not see that happening, either in your figures for 1988-89 or in my experience. Should we build more acute care beds in this province right now?

Mr Cunningham: I am going to go back to what I said earlier, that I would be dishonest if I tried to answer that. I can say that our hospitals in this province are giving good value for dollar and they are giving good management, but I do believe we lack an overall provincial planning system. Again, the association has said to the Ministry of Health and we will say to the public that we are willing to take part in a better planning system. That might help resolve that question. I think we lack provincial planning.

Mr Sterling: I do not care if you lack provincial planning. I represent an area that is served by the Queensway-Carleton Hospital. Some of my constituents, when they go there in emergencies, have to be put in the hall and all that kind of thing. Queensway-Carleton was promised 100 acute care beds by the last government. The argument against giving them those beds was that they were going to create clinics that would draw away from it, but that is not happening. The patient goes to the clinic; if it is a difficult case it gets shifted to the hospital anyway. Why bother with the damned clinic if all they are doing is creating another intermediate service, which is costly, and shoving it on to the hospital anyway?

Mr Birkness: Clearly, to make up for the loss of many of the acute care beds, a lot of out-surgery is being developed, and trying to move patients through the system by changing to this community care type of service. Obviously, when you can go to certain hospitals and find on a continuous basis, day after day, that people are being left in hallways because there are no beds to put them, where you find that people are on waiting lists and those waiting lists are getting longer for certain types of surgery, obviously there is a shortage of hospital beds; there may be a shortage of operating rooms and medical and nursing services for those particular needs.

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We do feel there is no room to cut any more acute care beds. We already have the problem with those that have been cut, those which, as you say, were promised and never brought on stream. It cannot continue. That is the message I have been bringing to the minister, to the Treasurer, the message I bring to you today, that we may not have a problem tomorrow, but I can assure you that we will have a problem in the very short term, if it is not in the very near term, the next six months or year. If we continue to cut beds, with our aging population we know very well that we are going to have a real problem in hospitals, because in spite of moving services out into the community there is going to be a definite need for additional acute care beds in our hospitals.

Mrs Sullivan: By way of a preamble, this morning when the Minister of Health and deputy minister were in front of the committee one of the questions put to them related to increasing in the next couple of years the health budget to allow for transition costs from an institutionalized system into more community-based care. The deputy was perhaps very perspicacious in not responding directly, but he certainly left us with the impression that while there probably would not be that kind of interim funding request, what there would be within the budget request would be a larger portion directed to increases which would stimulate interest in change.

I look at my own community and see things which have occurred there. It is served by three hospitals: Oakville, Milton and Burlington. It is a growing area. We have just received allocations and almost have shovels in the ground for additions to two of those hospitals. Additionally, all three hospitals are very involved in the transition and will be involved in the delivery of services in a different community-based situation. In the next phase of development they will not be looking at new hospital space but may be looking at satellite, day-surgery operations, along with other kinds of therapeutic care and counselling and whatever.

As I see that and as I look at your page 13 talking about additional costs which have not been quantified -- and this will affect, I assume, this year's budget. These are things you do not know about in terms of your analysis of what will be required this year in your operations. What I do not see is an indication of the pressures that will be on the hospitals in terms of participation in a community like mine. I do not know if it is different in Metro Toronto, but in a community like mine, where the hospitals are very much involved in being deliverers of a community-based system, I think, for instance, of nurses who may have to travel into people's homes. Where are those travel fees, other aspects? I just do not see it there. I know it is causing pressure in my community and I am wondering why it is not there.

Mr Birkness: Our global budget here does not take into account the breakdown of each individual hospital. Each hospital, of course, would present its own budget. We are telling you what the overall needs are of hospitals. We have within that, under appendix B on page 9, under "New and Expanded Programs," $107.3 million, representing 1.65% of our needs. That amount will be allocated to these new projects and a new health care delivery service of which you speak.

Mrs Sullivan: So it is in there. Do you want to speak at all about these unquantified costs that are likely to be coming up within the next budget year?

Mr Birkness: Are you talking about the impact of the GST and workers' compensation and so on? What more can we say about that, Gordon?

Mr Cunningham: I think it is just to alert that sometimes there are other costs imposed upon hospitals and we will have to accept them if they come. We cannot pass on by taxing the local community, we cannot pass on by charging more. We are simply alerting the committee to the fact that sometimes we have extra costs imposed.

Mrs Sullivan: Some of those changes in workers' comp costs will certainly be in-year in the next fiscal year.

Mr Birkness: Yes. That is why we addressed these. We know these are going to impact on the global budgets of hospitals so that hospitals are going to have fewer dollars to address the needs of patients, patient care.

The Chair: I would like to thank you for coming to make your presentation this afternoon.

INCOME MAINTENANCE FOR THE HANDICAPPED CO-ORDINATING GROUP

The Chair: Our next presentation is from the Income Maintenance for the Handicapped Co-ordinating Group; Christopher Watts, chair.

Mr Watts: My name is Kit Watts. I am the chair of the Income Maintenance for the Handicapped Co-ordinating Group. As some of you may know, we have presented to this standing committee before; this is our third year in a row.

Page 1 of our brief outlines our activities. We are a group of and for persons with disabilities, formed in 1978. Since then we have formulated strong positions on a variety of issues, most recently dealing particularly with the report of the Social Assistance Review Committee, Transitions, to try to maintain the momentum that was generated when that report was released. I would like to thank all of you for this opportunity to be here to address our concerns.

I would like now to introduce the other three people here today: Harry Beatty, legal counsel for our group; John Southern, who also was an original member of SARC, as some of you may recall; and Vera Malec, a member of our group and also the executive director of Views for the Visually Handicapped, which is a consumer group of parents of children who are blind or visually impaired.

We would like to finish within the half-hour time frame. We understand that a gentleman in the next group has a train to catch, so we would like to present as thoroughly and as quickly as we can.

Mr Beatty: I will address part 2 of our submission, which is the argument for continuing the social assistance reform begun by the Transitions process. Table 1 on page 15 of our brief indicates the growth over the past several years of the number of disabled persons on family benefits assistance, also known as Gains-D, guaranteed annual income system for the disabled. It shows that from 1982 to 1990 there has been a relatively steady growth of about 7% each year, and now there are slightly over 100,000 disabled individuals receiving family benefits as "permanently unemployable," to use the label in the legislation, which we do not like. Almost 50% have been identified as having primarily a psychiatric or developmental disability.

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We are naturally concerned, given the escalating social assistance costs in Ontario, that there will be pressure on this government, which has shown a strong commitment to social assistance, to slow down or perhaps even stop social assistance reform. What we want to argue is that social assistance reform, besides being better for people, is a more soundly based economic policy.

On page 3, we start to list some of the main points.

The first is competitive employment. One solution, of course, to the growing numbers of people dependent on Gains-D, which provides a basic income of less than $10,000 a year in most cases, is competitive employment. It really is the time to make some commitment to the employment of disabled people in this province.

We know the government is moving ahead with employment equity. We hope it will be effective. We hope we will start to see some effective enforcement of human rights legislation. But other supports are necessary as well.

Vocational rehabilitation services for people with disabilities are very underfunded. There are tremendous waiting periods. It often takes periods of up to a year even to get an initial appointment for service. You can imagine how well a small employer who may be ready to offer a disabled person a job is going to react to the news that there will be no involvement from vocational rehabilitation for a year.

I just point out, in the last paragraph under heading 1, the financial importance of vocational rehabilitation. If we say that there is a public expenditure of about $10,000 a year on each person with a disability under Gains-D, counting both the benefit and extra health costs and perhaps supported housing, a $20,000 rehabilitation and training program would, in effect, pay for itself in two years if it meant the person could get a job and be competitively employed. That is an oversimplification, but it may put it in some perspective.

There are American studies anyway that show that dollars spent on effective rehabilitation are cost-effective in ratios of 5 to 1, 10 to 1 or even better. If you have a good rehabilitation program which gets especially the younger disabled person out in an integrated way into the workplace, that makes a lot more sense than paying for a lifetime of dependency. It makes a lot more sense for the individual as well.

Second, we want to address the overlap between Gains-D, which is social assistance, and other disability compensation systems.

Table 3 on page 17 of our report shows that almost 15,000 Gains-D recipients also are getting benefits from other programs. One of the things that we want to look at of course is, are these other programs providing adequate benefits? Are they treating people fairly, or is the real reason that we have the escalating numbers of disabled people on social assistance, at least in part, that the other contributory and premium-based programs that they are paying into, that their employers are paying into, are not providing adequate compensation?

They start by noting that of the some 100,000 disabled persons getting Gains-D in Ontario, almost an eighth, 12,500, also have CPP disability pensions. These are people who have worked and contributed sufficiently to qualify for CPP disability. Yet you can see that they are getting an average payment from CPP of $501. That is all they are getting. You can add to that other people who have worked and contributed to CPP and, because of the technical and unfair eligibility rules, do not get anything and wind up on social assistance. This is the kind of thing that we hope the government will examine.

Another point about CPP disability is that there is no provision in their legislation for rehabilitation or any kind of earnings exemption. Their policy is still that if you get back to work, even on a temporary basis and maybe even if you go for training, they are going to take your CPP disability pension away. You can imagine the effect that has on CPP disability pensioners who may be considering a return to work. What if they try to go back to work and cannot do it after all? Their pension may be gone.

You may also notice almost 2,000 injured workers getting both workers' compensation at an average of $300 a month and being so poor that they qualify under both the income and asset tests for family benefits. It really would be instructive to review these cases.

Workers' compensation is often portrayed as a very rich system. There is no doubt that the initial level of benefits is much higher. Temporary benefits are much higher than a government general revenue, social assistance program like Gains-D offers. But once people had been in the system for several years, at least under the old system, people were not getting those high benefits; they were getting 10% and 15% pensions. I think any MPP would be familiar with that from his own office.

We really think that the relationships between these different programs should be looked at to see if some of these contributory plans, and I would include private long-term disability insurance as well, are in fact under- compensating people or in some cases denying them benefits altogether.

The next area is special-needs funding and John will address that.

Mr Southern: I would like to thank the committee for letting us appear before you once again. I know last year I joked about becoming an honorary member of the committee. Sometimes I think I should.

I just want to say that you must receive a lot of briefs and presentations. You could become blasé about them maybe, whatever, but reading Harry's brief today that he prepared for our group, it held my attention. I have been involved in social assistance issues for 11 or 12 years now and I still found it informative. I suggest that you read it from page 1 to the end. It really is good.

Talking about special needs and supplementary aids and whatever, there are often times when certain items that disabled people need are not available under family benefits or other plans and they have to go to the local municipalities to get this assistance, bandages or some certain kinds of equipment that are not covered by the assistive devices programs or other programs.

In these recessionary times, some of the municipalities are cutting back and some of them are so small they cannot afford to provide this assistance. As I found out when I was a part of the Social Assistance Review Committee, there are some municipalities that are very rich that do not want to provide this assistance as well, which shocked me to the core. Therefore, we recommend that supplementary aid be transferred to the province and that people should have a right to the things they need to lead a dignified life.

I guess one reason I got involved in social assistance issues is that when I first came to Canada, I saw the plight of disabled people in this country and how poor they were. There has been some improvement but not a lot. A lot of disabled people still remain living under the poverty line. I can speak somewhat from personal experience in this area.

I would really like to see the rates of social assistance raised. This government did raise the social assistance levels of people on Gains-D by 7% and also we really would like to thank the government for raising the shelter costs, but we believe another raise in the level of social assistance is necessary this year. They are certainly behind the eight ball, as Harry pointed out. The average person on social assistance is only receiving around $10,000. There are too many people living on that kind of income and it is nigh on impossible.

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Also, I would really like to see an improvement to the assistive devices program. As a start, we would like to see the age limits in the assistive devices program taken out of it and have it apply to people of all ages. That was promised in 1989 by the previous government and that has not been realized yet. Of course, after that is achieved, we would certainly like the 25% that people have to pay under the assistive devices program, for those who cannot afford it, there should be some way that can be covered. A lot of people spend so much time trying to acquire this funding, it is ridiculous.

Also, talking about the assistive devices program, the supports to employment program and all these other programs, it is all very well to have these kinds of programs and to encourage people to join the workforce again. A person who has just recently started to work with myself at PUSH would like to leave family benefits altogether and become independent, but the person has extreme costs. They need about $5,000 a year just to maintain the wheelchair.

Under the assistive devices program, for example, repairs are not covered. Where else does this person have to go to get this kind of assistance? Disabled people have been sort of reliant on charities for too long. Most disabled people I talk to are not willing to go out and beg any more: "We've got our rights and we want a dignified way of life now."

Also, we would like to see obviously extra health costs covered, certainly for the working poor. They should have an opportunity to avail themselves of the health plan. Again, when people on family benefits want to leave the system and go into the work force, some disabled people have extraordinarily high health costs and there is just no help for them. Sometimes it does prevent them from leaving the program, and in fact sometimes does prevent them from taking employment. I can think of at least five cases myself, people I know. I think this really needs to be looked at and studied a lot closer.

I will pass it over to whoever is next on the list.

[Failure of sound system]

Ms Malec: -- most families cannot work their way through. There is no one generally who can advise them on how to co-ordinate the effort. Many families are not then given the opportunity to access the programs that are available to them, but they just do not know how to plug into the system properly.

Within that report, it suggests integration of the services of all ministries with programs for children. Some of that committee's goals were to make the wellbeing of children and the defence of their entitlements society's priority, create an equitable economic base for families in communities so that they can provide the entitlement of children, make government a leading partner in the creation of a public agenda for children and provide an integrated framework of services that ensure children's entitlements.

The Minister of Community and Social Services told the Ontario Legislature that these goals are supported by this government. That is Mrs Akande. She was a member of that committee prior to being elected.

For the infant and preschool population, there is a serious need for immediate and ongoing intervention from infant development programs. Again, there are some services. They are scattered. They are regional; accessible here, not accessible there. Again, no co-ordination, and this begins right from diagnosis. In many cases the diagnosed child is handed back to the family without any support. It is specifically true in the cases of sensory impairments -- hearing and vision losses. It is true in most disabilities, but specifically there.

What we are hearing from teachers in the school system is that particularly sensory-deprived children are coming into the school system at anywhere between the ages of four and six with no preschool intervention, totally unprepared for an education, and in most cases they will never catch up. So we are losing those children.

Within our brief we have talked about the funding increases for the special services at home program. I know that the presentation after ours is the Provincial Coalition on Special Services at Home and I think they will probably give you all the information. I just would like to say though that the funding increases definitely need to be made in this program. Some $10 million had been assigned to the program over the next three years -- totally inadequate. It must be put in place within the 1991-92 fiscal year to have enough serious impact on that.

That is pretty well all I wanted to say in regard to the children's needs.

Mr Watts: Any questions?

Mr Phillips: I appreciate the presentation very much. I look back on the election and I think the previous government felt it was moving forward on the agenda. I think many groups, like yours, did not feel we were moving fast enough. I think the new government was elected on a platform of accelerating the development. I guess the role that we play -- what we will do, or what I will attempt to do -- is to hold them accountable for doing it, because I think in both An Agenda for People and the throne speech there were commitments made to your group to continue the progress. I have a lot of empathy with the needs of your community and with the need to continue that agenda.

All I really wanted to say was I think in both the throne speech, as I read it, and An Agenda for People, there is a commitment to do the things that you say are in the brief. As opposition, I guess the role of all of us is to make sure that that in fact happens, to the best of our ability.

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Mr Watts: We recently presented to Allan Moscovitch's Advisory Group on New Social Assistance Legislation. That was the advisory group that was launched by the new minister, as you say, Mr Phillips, to accelerate the whole process of social assistance reform. In terms of the immediate needs, most particularly the rate of increases that are necessary, people on family benefits experienced as of 1 January a rate increase and also an enhancement of the shelter subsidy. We suggested to the advisory group at that time that we look at a further 5% in the 1991-92 fiscal year, that is, over and above the regular 1 January rate increases, a 5% rate increase and 5% shelter subsidy over and above that. I thought we would just inform you of that to be consistent with the other group.

Are there other questions about some of the recommendations we have made?

The Chair: Seeing none, I would like to thank you for your presentation and your brief.

PROVINCIAL COALITION ON SPECIAL SERVICES AT HOME

The Chair: Our next presentation is the Provincial Coalition on Special Services at Home.

Mr Cartan: My name is Doug Cartan. I am chairperson of the Ontario Association for Community Living's task force on special services at home. I am also a co-chairperson of the provincial coalition on this particular program funded by the Ministry of Community and Social Services.

The coalition is made up of virtually all major disability organizations in the province. I want to introduce to you again today Christopher "Kit" Watts, from the Income Maintenance for the Handicapped Co-ordinating Group; and Bob Johnston, who is the chairperson for the Coalition for Family Support Services.

I want to chair this section for our group and, first, say to you that we are putting a microscope on one of the flagship programs in Comsoc's portfolio. In doing that, I want to stress the fact that the message we bring to you today is endorsed by virtually every major disability organization in the province. It is a very serious program.

I would like to turn it over to Kit Watts for some introductory remarks, and then to Bob Johnston.

Mr Watts: My task is to refer you to pages 1 and 2 of the brief, which basically gives the background of the SSAH, special services at home program. The program was initiated by MCSS in 1982-83 to respond to families whose children had a developmental disability and were under the age of 19. Families were able to apply to the ministry directly for an amount of money that would help them provide individually tailored services to meet their child's needs.

There are three main characteristics of this program which made it a very beneficial program for families in these circumstances and, I would like to add, perhaps may act in future years as a prototype for the government to more seriously consider a user control approach to funding.

First, there was flexibility. The families were able to access the program not based on specific criteria which may have excluded them; rather, the criteria were tailored to meet the individual family's needs, keeping in mind that individuals with disabilities living at home with their families have a wide variety of needs and therefore quite individualized requirements.

Also, the program provided portability, in that rather than the person having to live in a certain location to access the program, the program could follow him wherever he was in the province.

The families had choice and control over the services they were requesting and receiving and they also had the control or the option of controlling the funds provided to them directly.

SSAH is also supported by users because it enhances the security of the whole family. It allows the child or children in question to remain at home, avoids institutionalization and provides a normal access to their community.

But by 1988, there were about 6,000 children making use of special services at home, for a total of $14 million in support. There started to be problems associated with the inadequate funding of the program. As is the case with many programs we introduce, we just have no idea how the demand will increase. Sure enough, this is what happened. It became much more popular than anyone had anticipated, and as a result there has been a shortfall of funds over the past several years.

In September 1990, just prior to that, the previous minister, Charles Beer, announced an expansion of the program to include two other quite large target groups, children who have physical disabilities and adults who have developmental disability. To offset the increased costs that these many more thousands of potential users would need, he allocated an additional $10 million, as was mentioned by Vera Malec in the previous presentation, to be added on an annualized basis over the next three fiscal years. By fiscal 1992-93, there would therefore be approximately $24 million allocated to the program.

I would like to turn it over to Bob. He will explain further what our expectations are based on the inadequacy of the present funding.

Mr Johnston: Thank you for allowing us to speak to you today. I would like, before I review the short portion I have, to emphasize that this is indeed a coalition of a variety of organizations, which are listed on the final two pages of your document. The emphasis I would like to make is that we are coming together for one of the first times as a true provincial coalition, representing different segments of the society which is called "disabled." That would be, in this case, developmental disabilities and physical disabilities. We have come together in the principle of supporting one another rather than attempting to grab what we can for our segment, so all through this whole process we have emphasized with the ministry people we have worked with, and we do so today emphasize, that we want this program to work for all of us and not for some of us.

As it says here, special services at home is a flagship program in the ministry's plan for family support and the effort to curtail institutionalization. Indeed, this program is in many ways a response to the philosophy of deinstitutionalization.

Prior to the announced expansion and extension effective September 1990, the program, as has been said, was seriously compromised as a result of the demand for funds outstripping the availability. The problems were evidenced by things such as: parents in some regions of this province experiencing direct cutbacks to their SSAH agreement; families being asked to cost-share in some areas. Also, funding for some uses of the program, for example, parent relief, is being either cut off or restricted if there is a base-funded agency in the community. Families who do not use all of their approved hours of support in one contract period are experiencing a reduction in approval during the next contract period, which may imply to you some usage in a period when it may not be necessary to the family through fear of losing it in the future when it is necessary. Waiting lists are being established in several areas of the province and new applications are not being considered. Equipment for children and transportation costs for workers funded under SSAH would no longer be funded.

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In addition, the recently announced expansion and extension would allow access to the program by an additional 12,000 families in those two new groups we have mentioned over and above the 6,000 served prior to September 1990, while adding just $10 million in new annualized dollars to the current $14 million. The $10-million increase will not be fully realized until fiscal 1992-93.1 do not think it takes much in the way of mathematical thought to realize that if we go from 6,000 to a potential 18,000 people and we do not even double the money, something is going to break down. Pressures are being compounded as a result.

The current situation is that applicants for assistance by the newly eligible groups are being turned down, in particular the newly eligible groups, including, for example, adults with a developmental disability. In the case of families where the parents may be in their 60s or 70s and the child, who is indeed an adult, is in his or her 40s, applications are not being accepted in many cases for this newly eligible group or supposedly newly eligible group.

Workers funded under the SSAH program are the lowest-paid human service workers in this province, lagging 60% behind institutional workers. The emphasis may be on deinstitutionalization, but there is no recognition of that in the compensation for the workers in that area.

Family contracts are not approved for more than 12 months at a time, resulting in great insecurity for these families as they approach the end of their contract, just as each of us would be very concerned if election day were rolling around or if we were under a contract at work and did not know until the last few days or indeed until after the expiration date whether we were going to be renewed. It causes insecurity.

Recommendations:

1. Commit the entire $10 million that had previously been allocated to take effect by fiscal 1992-93, and move it into 1991-92 to deal with the current program pressures.

2. Commit to SSAH as a primary home support option for families rather than as a program of last resort, as it seems to be implemented in this province now. It really is a program of last resort.

3. Commit an additional $30 million annualized, which would then total $54 million annualized, by fiscal 1993-94 to support the new and existing groups of eligible individuals and families.

Perhaps we should ask if there are some questions.

Mr Phillips: I just want to get it straight. You are many groups. I guess each group might come with another issue, but this is one that transcends all.

Mr Johnston: Across the board.

Mr Phillips: I do agree with the point you made earlier that that concept is important, of essentially the consumer or whatever you want to call them, the individuals, having control over their services as opposed to what often happens with government, which goes the other way. You make a good point, because many of our community-based services could think about that model for home care and things like that.

What do you feel the ultimate demand for the service will be? Is that approximately $50 million in today's dollars on an annualized basis where you think the total demand will be?

Mr Watts: Back in the spring, Richard Allen, who was then the opposition critic for the Ministry of Community and Social Services and, of course, is now the Minister of Colleges and Universities and Skills Development, at that time mentioned in a press conference organized on behalf of this program that, based on the existing figures, in 1990-91 dollars, if all the potential users of the program were to approach the ministry for funding the need would be in the area of $120 million to $130 million. The program was introduced almost l0 years ago, and of course was applauded at that time for its many forward-looking features, but we are lagging behind badly now. That is basically what the demands would be.

It would be very interesting, for example, to see what would happen if all of a sudden that money were freed up. That would help us a great deal with our social research, to see just who does come forward, and also compare that to the enormous number of dollars spent institutionalizing young people, developmentally handicapped adults and so on, who could viably be remaining at home with their families.

Mr Phillips: Give me the number; it would be helpful. I think you make a good point about the difference in cost if you were institutionalized. How much per individual, roughly, does this program cost per year?

Mr Cartan: Right now, with about 6,000 families accessing $14 million, you are in the $2,500 range. A group home bed in my community is $150 a day.

I also want to add to what Kit said. The Easter Seal Society has given us some pretty clear statistics about the number of physically handicapped children it can pinpoint right now. That is an additional 6,000 children it figures will have access. For the adults with developmental handicaps, there is no clear research done on that but looking at information from StatsCan and cross-referencing that with the health and activity limitation study, we have the most conservative estimate of another 6,000 families who have sons and daughters who are adults with developmental handicaps living at home. So this is a conservative estimate for this program.

Mr Phillips: About $2,500 per individual, is that right, per year?

Mr Cartan: Per family.

The Chair: Seeing no further questions, I would like to thank you for your presentation.

ONTARIO FEDERATION OF STUDENTS

The Chair: The next presentation is the Ontario Federation of Students; Tim Jackson, chairperson, Greg Elmer, communications director.

Mr Jackson: Our apologies for not having the brief in advance. We received short notice of the notice to present and were away last week. La Fédération des étudiant(e)s de l'Ontario représente environ 240 000 étudiants et étudiantes dans la province.

I would like to go through the brief very quickly and just highlight and expand on some of the areas that are mentioned. About three years ago the federation unveiled a document called Cut to the Bone, which outlined underfunding problems that existed in the post-secondary system in Ontario. The report got a fair bit of attention but very little action from the government. The report talked about deteriorating laboratory equipment, increased classroom sizes, increases in the hiring of part-time instructors as opposed to full-time professors.

The federation has always believed in a high-quality, fully accessible post-secondary system. We reaffirm our commitment to work towards a strong, truly publicly funded education system, something which the government outlined in its throne speech when it talked about strong, publicly funded institutions.

Over the past few years the situation has gotten worse and worse. The previous government introduced programs such as the employer health tax and pay equity legislation, legislation which in and of itself may be very good, but provided no additional funding to universities and colleges to make up the increased expenditures. Universities and colleges in the province, their revenues are fully controlled by the government, both through operating grants and tuition fees. Therefore, there was no way for the institutions to increase the costs.

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The previous government also had a habit of introducing what it would call accessibility funding. It would tell the universities and colleges that they could take in X number of new students. The universities and colleges would receive funding for those students in the first year. Unfortunately, the universities have to take those students through years two, three and four and subsequent funding for those years was not forthcoming. Therefore, we are in a situation right now where operating grants per student over the past l0 years have decreased significantly. In real terms the operating grants per student at universities in this province are almost $2,000 less than they were in 1978, which means the universities, as we said earlier, obviously have had to increase class sizes and increase the number of professors that are not on tenure, ie, part-time lecturers. In fact, it leads to a lower-quality education.

We do recognize that part of the blame for this rests with the federal government through its cuts in transfer payments, but we also believe that the province has to recognize that what Michael Wilson and Brian Mulroney are doing is very simply transferring the tax burden to the provinces. Transfer payments have gone down and will probably continue to go down and therefore the province is going to have to pick up its slack.

The way the provincial tax system works in this province, like most except for Quebec, is that the provincial rate is simply a factor of the federal rate. So, through Mr Wilson's tax reform, as the federal tax system got more and more regressive, de facto the Ontario tax system has become more and more regressive. We think that when the Fair Tax Commission starts to meet that is something that it is going to have to address to make the tax system in the province more equitable.

As an immediate commitment, the federation, along with the faculty, staff, alumni and administrations of universities, has asked the Treasurer to commit to contributing $125 million per year for two years. That would take Ontario to the midpoint in the country in terms of per-student funding. Ontario currently ranks nine out of l0 provinces in per-student funding. We believe that that midpoint by midterm is something this government should commit itself to, simply as a very short-term solution to try to stop the crisis that currently exists.

The Ontario Confederation of University Faculty Associations, when it presents, will speak a great deal about the professors who are increasing in the province. We share its concerns and support its position that there needs to be an additional 1,500 tenure track positions created in the province.

We would also emphasize, though, that this is a perfect opportunity for the government to introduce some sort of employment equity program. At the same time as increasing those positions, we would support some sort of affirmative action to increase the number of women who teach in faculties such as science and engineering and increase the numbers of visible minorities and other underrepresented groups. So in fact, the government could attack two problems at the same time.

We could not come today and not talk about user fees for post-secondary education. Over the past l0 years there has been a significant shift in the burden that students have borne. What were traditionally funded services out of a university's operating grant, such as student space, have now been shifted to ancillary fees, where students are now having to pay for the construction of study space, of recreational space and are paying other fees that previously had been covered by operating grants.

The student assistance plan in the province is woefully inadequate. That has been acknowledged by government, staff, students, faculty and alumni. Everyone agrees that the system is inadequate. As provincial revenues have gone up, the amount of money that has gone into student assistance has not gone up by the same proportion. What we would like to see is some sort of commitment from the government to let us know whether it is willing to revamp the entire student aid system or simply willing to tinker with the system that currently exists.

If tinkering is the way that the government wishes to go, simple things such as the living allowance that students are expected to live on under the student assistance plan have failed to keep pace with inflation. The living allowance currently sits at $121 a week. We estimate that the actual cost to the student living away from home is closer to $221 a week. If the living allowance had at least kept pace with inflation, it would sit at $175 a week. So it has not even kept up with inflation.

Several years ago, we asked the then Minister of Colleges and Universities if she would be willing to try to live on the living allowance for one month during the summer, and she said she would not. We quite frankly believe that is because she believed that you simply could not. We would challenge anyone to live on $121 a week, especially in a place like downtown Toronto. That living allowance covers everything from transportation to meals, to rent, to electricity, to transportation.

Compensation must also be made for the 7% goods and services tax which now applies to textbooks.

Income-contingent repayment plans have been suggested by people recently as a method of paying back student loans. We do not question for one minute that an income-contingent repayment plan would be better than the current Canada student loans program.

The problem is that anyone who proposes the contingent repayment plan does so at the same time as proposing significant increases in tuition. For that reason, we reject the plan.

In dealing with the Canada student and the Ontario student loan program, we would suggest that the government should look seriously at running the loans itself. Currently the loans are run through chartered banks in the province. The loans are 100% guaranteed by the province and by the federal government with a Canada student loan. It is very easy money and simple money for the banks. There is absolutely no risk and we would suggest that it would be better administered through the provincial government.

Who pays the price for post-secondary education? The OFS has always advocated a system without user fees. However, we have also advocated the position that we must repay society.

For the policy manual, we stand opposed to increases in tuition fees for education and we call for the progressive abolition of fees. We do recognize the obligation of the individual to reimburse society for the benefits accorded by higher education, and it is our belief that the most equitable method of meeting such an obligation would be a reformed system of taxation which would be borne by a student only after graduation and hence not pose an economic barrier to prospective low- and middle-income students.

What we are saying is, eliminate the tuition fees, freeze them in the short term, eliminate them in the long term. However, the question always comes up, "Well, where should the money come from?" The money should come from us, as students, and the money should come from us after graduation through a progressive income tax system.

We also believe that corporations are a beneficiary of the post-secondary system. If undergraduate teaching were to cease tomorrow, research and development would still have to continue and the costs would be borne by either corporations or by the government, and therefore we do feel that through the corporate tax system there should be revenues raised towards post-secondary education also.

In conclusion, I guess the government is going to have to make a decision and that is that we are at a crisis point right now where universities are going to simply have to reduce the number of students they take in to provide any sort of quality education. This government is going to have to decide, does it want an education system that few can get into because there is not enough money, which means of course not only that students do not get an education but that jobs are lost through faculty and staff, or is the government willing to commit proper funding and full funding to the post-secondary system, which we believe in the short run would in fact cost them less money?

We believe that government was elected with a mandate and that mandate was not to pick and choose between options that have been presented to it since the election; the government was elected with a mandate to provide strong, publicly funded institutions. If we go back to the football analogy that the member for Brantford used at a rally we had, the Conservatives had the ball and they fumbled it. The Liberals had the ball and they fumbled it. Now we have the ball and we are going to take it for a touchdown.

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The initial indications of the operating grant increase that will come next week are that in fact the NDP will not be taking it for a touchdown but will probably be tackled behind the line of scrimmage, and therefore we believe that it is imperative when the budget comes out that the NDP make up not only the lost yardage but that it does in fact take it for the first down and then a touchdown, because it is not going to happen next week. I think, as committee members you are going to have to do something when the budget comes out.

Mr Sutherland: It is a pleasure to see you here. I want to ask you a very frank question. I have been receiving the paper from Western, both the administration paper and the student newspaper, and am quite alarmed at some of the things I have certainly been seeing. The decline is going down there quickly. I know that Western traditionally is a better-off university than many of the other ones, and colleges, in the province.

My question to you is, realizing that we are in an immediate crisis, if you had to choose between one or two things, either zero tuition or making sure there is more money in the system overall, which one would you choose right now?

Mr Jackson: I guess when I ran for this office, Kimble got to grill me and it still continues.

We have always said that zero tuition is a goal of ours. We do not believe it can be obtained in the short term. Our short-term solution would be an immediate freeze in tuition fees and then some sort of plan. We have indicated our commitment to work with the minister and with the other groups to come up with a long-term plan to eliminate tuition fees.

We believe that in the very short term this government can amend the Ontario income tax system to make it more progressive than it is now, again coming back to the fact that it has become de facto more regressive as the Tories in Ottawa have made theirs more regressive. With very little effect on the budget, you can freeze fees for this year and over the course of the next 12 months, we think we can come with a plan to eliminate fees and replace those revenues through both the personal and corporate income tax system.

Mr Sutherland: Could you just inform the committee as to what the percentage of university funding is now? Not percentage but the overall dollars of university funding now by tuition fees?

Mr Jackson: Tuition fees cover about $440 million.

Mr Sutherland: Okay. The expectation would be, then -- freeze them; all right.

Mr Phillips: I am looking for the touchdown, as I said to the previous group. I guess I am sensitive to these things because we were doing what we thought was best. I look back over the past five years and certainly operating grants and the capital grants for colleges and universities went up well in excess of inflation. Now, you have another government and it promised a touchdown. I guess all you can expect from us as opposition is to kind of cheer you on as you expect to get a touchdown. You are right that next week, if the grants do come out, it will be the first test of where on the field the left end is.

Mr Jackson: The biggest problem we had with the previous government was that an announcement would come out, grants have gone up by 7% one year, 8% the next year, which sounds wonderful, except that the government has said --

Mr Phillips: Nine per cent last year.

Mr Jackson: Eight and the additional at budget time.

Mr Elmer: It was more like 2%. That is why Kimble brought up a very good point at Western. They cut back in their budget by 2% across the board.

Mr Jackson: The problem is, that is fine to increase them by, whether we take 8% or 9%, but when the government has also said, "We want you to take in X number of new students on a per-student basis," last year's grants, when you took off that enrolment bulge, the employer health tax and the pay equity the actual increase was 2.5%, which was less than the rate of inflation.

I think that is the past and what has happened has happened. What we would like is a commitment from the new government, if it is going to increase spaces. that it fully fund those spaces through all four years. We will be working with you to make sure that happens.

Mr Phillips: I know those guys.

Mr Jackson: I will be working with you to make sure they do it.

Mr Sutherland: I wanted to ask about another specific area of OSAP. I have had several calls lately from my constituents concerned about how OSAP is working for part-time, and more specifically, mature students. I was wondering if OFS has done any research on that or developed any policy on what specific reforms should be occurring on OSAP for mature students. I am sure, as the gentleman who is going to be speaking after you will probably address, many of them are low-income people.

Mr Jackson: We have done some very specific work on that and have met with ministry officials over the past few months. It is primarily a question of access to OSAP, that is the biggest thing, for part-time and mature students. We can continue to make suggestions that tinker with the current student assistance plan, but the general feeling by everyone, including I think the minister and the deputy minister -- I guess the deputy minister until yesterday -- is that the whole plan needs a revamp. We need a commitment from the government to undertake a comprehensive study of OSAP, with a commitment to revamp it at the end of it. We will continue to tinker away with it and we will be meeting with the director of OSAP to discuss the specific ideas we have for mature and part-time students. We would much rather revamp the whole system and start from scratch, but if it is the will of the government to keep tinkering with it, we will.

Mrs Sullivan: I am interested in the portion of your brief in particular which relates to faculty on campus. I note that you are supporting OCUFA's position on the creation of 1,500 new tenure track positions. A short time ago, I cannot remember whether it was in the 1986 or 1987 budget, there were additional moneys provided to the universities for faculty renewal. Indeed, they were welcomed by the universities. Perhaps everything could not be done at once, but there was an attempt made. Around that time as well, and perhaps a little bit before that, there was some consideration among the universities themselves that a more appropriate way of renewing faculty was indeed not the tenure route, that the tenure route was in fact discouraging faculty renewal, and that the new, eager, creative people were being cut out of the process through that route. I wonder how you have come to the conclusion that that is the best way to go in terms of faculty renewal, which is clearly a goal we all share. Why have you reached that conclusion?

Mr Jackson: I think the biggest problem with non- tenure track positions is access to the instructor. What is happening right now is that as universities are forced to cut back, they hire part-time lecturers. In faculties like accounting or similar programs, they hire actual practitioners from the local region. The problem with that is that students have very little access to those people outside classroom time. A part-time lecturer will come on the campus, give his or her lecture and then leave campus.

I suppose at the same time there is the problem that if you do not have tenure track positions and you do not have full-time faculty, what is happening with the research? The logical conclusion is that research is either not being done or is being done by corporations. The problem again, when we come into this whole notion of corporate research, is that it eliminates this whole notion of academic freedom, because the funds have come in from a company that wants research one way or another. Eventually there is going to be a void of research that does not meet the objectives of IBM and the corporations that can afford to pay for it.

So I guess it is twofold, but the more important specifically for us is the lack of access to the instructor when he or she is not in a full-time tenure track position.

Mrs Sullivan: I think it is interesting that it is a matter of access. You feel that students need more time and that there is not possibly space for them to be housed on campus and that the income they are making does not allow them to spend more time there.

Mr Jackson: And if I can add to that, it is compounded. As the classroom sizes get bigger, you have less direct contact in a classroom with an instructor and then you get less direct contact outside the classroom.

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Mrs Sullivan: Do you see any other alternative to tenure to meet the same goals? These are budget issues, very much budget issues.

Mr Jackson: I think whether it is tenure or not tenure, our point simply has to be that there needs to be funding to allow the university to hire someone who can be on campus full-time, as his or her full-time employment. The question of tenure in terms of job security, which is generally the problem with tenure, is another question. As an immediate direct answer, we do not care if people are tenured or not as long as they are on campus constantly and that is their job. But when their job is elsewhere and they come on to campus for three hours, that is where the problem is.

Mrs Sullivan: So then you are not fully in support of OCUFA's position?

Mr Jackson: Oh, yes, we are. We fully support the position, but if you are telling us we are either going to get nothing or we are going to get full-time lecturers, we will take the full-time lecturers.

Mr Elmer: Essentially, it is a question of quality of education as well. Tim mentioned one point, and that is access to professors, but it is not just that. People who have the experience are usually the people who get tenure. I do not necessarily agree with your presumption that all these get-up-and-go type, aggressive people are not getting those jobs. I disagree with you on that point.

Mrs Sullivan: That was something that came out of the university community three or four years ago.

Mr Elmer: Yes.

Mrs Sullivan: It led to the grants for faculty renewal, and that is why I am pursuing it.

Mr Elmer: Just to reiterate my point, it is a quality of education issue, and that is why we do agree on a lot of points that faculty bring up, and obviously vice versa, as well as staff associations, and you are right, it is a budget issue.

Mr Kwinter: Just to pursue this whole topic of tenure, it is a subject that I am very familiar with. I waged this battle with OCUFA many years ago while I was the vice-president of the Ontario College of Art. OCUFA's major rationalization and defence of tenure is to give faculty members academic freedom to disagree with the administration, to disagree with society per se. We have a situation at Western where we have a professor expounding a particular theory on genetic relationships to achievement and things of that kind and tenure protects him.

I think there are other mechanisms for protecting people in today's society. At one time, tenure did serve that purpose. Right now -- and when I say this, it is certainly not a universally held opinion -- tenure really equates to job security. OCUFA is a union. They demand tenure because it gives their members job security. It gives them job security where most other people do not have job security. Again, this is a personally held view.

I do not want to generalize, because there are first-class professors who are tenured. There are also less-than-first-class professors who are tenured, but they have that protection, and it absolutely has an impact on the budget. You have this complement of professors at post-secondary institutions who are there. Again, with all due respect, it is like a civil servant. There is nothing more permanent than a part-time government employee. What happens is that it does impact on the whole academic-financial relationship.

I would be curious to hear the arguments as to why tenure is that important when you can resolve a lot of your problems by having people whose sort of key to permanent employment is competence. If they are competent, they will be employed. If they are not competent, just like in any other field of endeavour, they will not be employed. Why should these people, given the impact it has on a very serious segment of our economy, the teaching of our youth and our adults and everything else, not be the best that are available?

Again, I want to be very clear that I am not painting with a universal brush. Most faculty members at universities are very competent and very able, but I think any objective observer would agree that there are lots who are not, and those who are not are preventing others who could be capable from getting into the institution because of the tenure track. I would like to hear some of your comments on that.

Mr Elmer: I think your point is valid, but I think you could also make the same point for the students that are in the system who do not deserve to be there or who do not work hard enough or what have you. There are also people who are represented by associations or trade unions that you could make that same point for argument. In fact, I am surprised that you bring up this point because I do not think that is in fact the debate which is currently going on in the post-secondary education community and, by extension, I would say the public as well. I think the debate these days is around democracy and decision-making in university and college institutions.

To bring it back to your point, I think that the way in which we can have some input as students, as public, as citizens, as taxpayers, is to revamp the university and college system whereby more people have a say in things such as tenure and things such as registration priorities, OSAP, appeals, all those different things which take place at the university and college level through the committees.

I would have to say that, coming back to the point I said before, we stand quite united with the faculty on this. This is an issue which is brought up again and again, and it is an issue that we discuss among ourselves in the university and college community. I think we have made a real effort in the past six months as faculty, staff, students and administrators to provide more of a common front. In the past we have tended to sit back and say, "Yes, I think that Mr Kwinter has some points," and we tend to attack each other on that. That is not the case any more. I can honestly say to you that is not the case, and I do not think it is the case that this is really an issue.

Mr Jackson: The biggest problem that we have had with tenure over the past few years has been this notion that we have argued that there have been some professors perhaps whose teaching abilities have not been measured the same as their research abilities.

No administrators under financial constraints are going to grant tenure to someone that they think is not going to give them some sort of resources. It just does not make sense, and I put confidence in the administrators of our universities that they would not do that. But because of underfunding, universities are having to look at some professors or potential professors based on their research value. How much can they bring in in research grants and what not? The teaching aspect of it is ignored.

We have absolutely no problems with the concept of tenure. Perhaps problems that exist today with tenure are, we believe, a symptom of underfunding, because if it was not for the underfunding problem, then we would be able to put a higher ranking on teaching when tenure decisions are being made. Why would a university administration -- and I have sat on boards of governors of universities that have granted tenure -- commit funds to someone who is not going to be a resource either from teaching or from bringing in research dollars? It does not make sense.

Mr Kwinter: If I can just comment, I think that in these times of constraint, I would agree with you. What I am saying is that the establishment is already in place. If there was an opportunity for renewal, if there was an opportunity to ask why we would have these people who were tenured 20 years ago, 25 years ago, who are not in a position to do any of the things that we use as our criteria today to tenure professors, why they are still in the system, the argument is: "Well, it is job security. These people have paid their dues and, as a result, they are entitled to it."

I am suggesting that is one of the problems. I am not in any way suggesting it is the major problem. The only reason I even entered into this discussion is that my colleague happened to bring it up, and I can tell you that --

The Chair: It is your fault.

Mr Kwinter: -- I have lived, I have had some historical input into what has happened and much of what has gone on with the changes in the governance of universities.

The present president of the University of Waterloo, Doug Wright, was a one-man commission that looked into the administration of the Ontario College of Art and came up with the first unicameral system. It was absolutely the model that was then subsequently applied to universities across this province and across this country. As I say, I am not in any way saying that this is the major problem that is there, but it is a problem and it is an ongoing problem.

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Mr Jackson: Yes, Doug Wright, who gave a workshop at a board of governors' meeting that I attended at the University of Waterloo where I sat on the board, talked about tenure and totally supported the notion of tenure. I would be very interested, if we asked him the same questions, in what his comment would be about that. Perhaps that is something we should do.

Mr Elmer: I think it is a valid comment. Now is the time for renewal. That is why we are bringing up these points. There is also the point of manager retirement that was upheld. You cannot take these things out of context. I think there are other factors which need to be looked at as well and that is one of them. But in terms of renewal, we are placing that, as I said to you before, in the context of the actual discussions which will be going on in the coming months and years over university governance, and we have a lot to say about that.

Mrs MacKinnon: I wish to commend you for your presentation. It is at times like this when I know my eloquence fails me. I never was very eloquent anyway, but forgive me if my question is very short and to the point. When one of my daughters was in university -- I mentioned about the tuition fee and I hear you talking about zero tuition. That frightens me and I will tell you why. When I was discussing my daughter's tuition, there was a person in my home who said. "Her tuition won't even put the bricks around the door." I realize that this particular daughter I am speaking of -- it was a few years ago, but I am wondering, if we have zero tuition, who is going to put the bricks around the door. Us, the government, is that what you are expecting?

Mr Jackson: No, I think us as graduates of the university and college system primarily, and that is what we have always said is our policy.

Mrs Sullivan: Through the taxes.

Mr Jackson: Through the tax system, through a progressive tax system, and without patting ourselves on the back. I think there is something to be said when I come her, as someone who hopefully will graduate shortly from an accounting program and hopefully will make a decent income and say to you, "Tax me for the post-secondary education that I have had." Our goal is to eliminate the financial barriers to post-secondary education, make sure that no one is denied access on financial grounds and recoup that through both the personal and corporate income tax systems.

Mrs MacKinnon: Thanks very much. As I said, I wish I was as eloquent as you.

The Chair: I would like to thank you for coming. I do have one short question and it does revolve around the replacement of faculty. If we have 50% of the faculty gone by the year 2006, are we at this time training enough faculty to replace them from this country or are we going to be back into the 1960s dilemma of having to import professors from other jurisdictions?

Mr Elmer: Actually, that is the debate which is going on these days. I sat at a meeting a few months back where you had people from the education community saying, "This is ridiculous," pointing the finger at university administrators and saying: "You are not letting enough people into teacher education programs. In fact, you are cutting back on the number of people who are being taught to be teachers."

That is a big concern. I know that is a big concern of the Teacher Education Council. They discussed that at some meetings they held about a month ago. It is a concern of our members as well, because what is happening is that as they are cutting back on the enrolment of the people who are allowed into that program, you have to get A pluses, straight As basically, to get into those programs at a time when the demand is, you are absolutely right, increasing and increasing.

Mr Jackson: But in terms of professors, it is over the past few years that the number of graduate students in this province has gone up significantly; the number of graduate student scholarships has remained frozen. As to the question of whether we can import them, the argument the other way that is going on right now is, are we losing too many to the United States because we cannot offer competitive salaries and, more important, can we offer competitive research facilities here in Canada?

Again, it is a symptom of the underfunding problem, but I think the point we want to emphasize is that if the government undertakes some sort of faculty renewal program, it is the perfect time to implement as well some sort of employment equity program to increase the number of female students in graduate programs in engineering and science, and thus eventually increase the female professorial in those faculties. Where are we going to get them from? That is a question that many would suggest right now.

The Chair: Thank you for coming.

ONTARIO COALITION AGAINST POVERTY

The Chair: Our next presentation is from the Ontario Coalition Against Poverty. This is John Clarke. If you would begin, please.

Mr Clarke: First of all. I would like to apologize for the fact that my co-presenter is not here. I am particularly chagrined that she is not here since I intended to do little more than introduce her. None the less, making the best of things, I perhaps would like to run over some of the points that we intended to make and which we outlined briefly in the letter that we sent to your committee.

We did want to begin by making the point that our function as an antipoverty coalition is not in that sense to function as a sophisticated think tank that can bring financial projections before a government for it to consider. Our role is more one of talking to the need that exists in the community and outlining some measures that we think will make a difference, measures that we think are modest but measures that are desperately called for.

We met last week with the Premier and discussed some of these questions, so I think they need to be brought out, and we would like to acknowledge that we are not insensitive to the fact that Ontario at the moment faces some very difficult times, that a recession is not just simply a human tragedy but has a direct bearing on the government and on the question of revenues.

We also would like to acknowledge that the government of Ontario faces a very difficult situation with regard to federal initiatives that are, it would be a gross understatement to say, less than helpful. We look at the impact of Bill C-21, the unemployment insurance bill. We look at the impact of the cap on the Canada assistance plan and we recognize that there is a real problem.

However, we are very, very serious about holding the present government to promises that it made during the election campaign. We understand the problems, but frankly we think the problem of a government with fiscal problems is a relatively modest problem compared to the problems facing poor people in Ontario, the 100,000 people a month in this city alone who have to go to food banks.

We would make the comment that the argument that there is no room in the lifeboat is a lot more appealing to the people who have seats than to the people who are expected to go down with the ship. Therefore, if we introduce into the debate around the initiatives that the government should take the irrationality of the desperate, we think that perhaps that is somewhat appropriate, that there is, in our opinion, a need to be straining every resource in trying to deal with the situation at the moment.

We would like to make the point when we address initiatives that are being taken around improving the welfare system, etc, that those are indeed important initiatives, but as far as we are concerned, the question of income adequacy is absolutely fundamental and is something that is going to have to be addressed if welfare reform is going to mean anything. In fact, welfare reform that is approached in such a way as to exclude movement on benefit structures, on the rates, threatens to be, in the final analysis, nothing more than a cosmetic diversion. The real issue is, are people going to be paid enough to live on?

In our opinion, that means dismantling an edifice of legislative poverty that has been built up in this province over an extended period of time. That means we would propose dealing with the minimum wage in a very, very serious fashion and in a very timely fashion.

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We are aware of the fact that during the campaign the call for the raising of the minimum wage to 60% of the average industrial wage was advanced. We also acknowledge that that was not promised in one go. But we would urge the government to move rapidly in that direction to consider returning the minimum wage to its 1975 spending level, which would mean about $6.50, we would understand today, as an important first step, and to move rapidly with a clearly mapped out timetable to raise the minimum wage to the level that was promised. It is certainly not a princely wage; it is certainly something that will make an enormous difference to hundreds of thousands of people in the province.

Similarly, on the question of social assistance, we think there are two key areas that have to be looked at in terms of moving towards adequacy.

One is with regard to the general welfare assistance system. If a government is interested in moving in the direction of welfare reform, it must be acknowledged that as long as you have municipalities picking up 20% of the costs out of an inadequate municipal tax base and as long as you face the situation where, going with that, you have an inordinate number of local discretionary powers in the hands of those municipalities, you are not going to achieve a process of welfare reform. Indeed, you are going to have initiatives taken that are going to be horrendous.

We are aware of the fact that there is brewing a veritable municipal backlash. You have things like Kent county passing a resolution calling for the freezing of welfare rates throughout the life of the recession. You have Hastings county wanting to go over the list of everybody who is on welfare at its council meetings every month. You even have the municipality of Ottawa-Carleton looking seriously at social services cutbacks, social assistance spending cutbacks. That is a very, very serious development, because Ottawa-Carleton traditionally has been viewed as one of the more liberal municipalities with regard to the implementation of the general welfare assistance program.

We do make the point, and make the point forcefully, that particularly at this time of recession and pressure on the municipalities, there is a need to move rapidly to dismantle the two-tier welfare system, which is by no means something that exists in all provinces.

We would also make the point that the antipoverty movement on the question of benefit rights has campaigned actively in the past around a call for an increase in the minimum wage by 25%. That is something that was supported by the present government when it was in opposition. We would say that is a realistic figure, that is a figure that would make a significant difference, that would hold the line on the food banks, and is the kind of figure that we have to be talking about if we are talking about alleviating the suffering of people at this time, let alone reforming the welfare system.

I would, just before I turn things over to Heather, like to make the point that our organization does indeed, as some are probably aware, have a history of mobilizing on poverty issues, raising the concerns forcefully.

Perhaps I would like to direct my comments primarily to the members on the government side when I say that a great deal has been promised, a great deal is expected. The situation we are facing at the moment is indeed a very, very desperate one and I think Heather is going to speak to it in a moment.

We would very much like to be an organization that found ourselves backing changes that were being introduced, rallying to support those changes, taking on the critics who oppose those changes, but in this present situation we are facing something that is so desperate, something that is so severe that we have no choice but to continue to press around those very basic and important demands that we have in the past.

So perhaps, Heather, you would like to add some comments.

Ms Pringle: I just wanted to speak to you today about a situation I found myself in for a while. I was not always on assistance, but it is also a situation that any person can find herself in who loses a job through circumstances beyond her control. It is a very degrading situation, humiliating, a thing to be avoided. The reason is that people treat you with such disgust because you find yourself in this position.

There are things like food banks, which are Band-Aid situations. It is a very humiliating thing to go to a food bank. They want to know your name, your rank, your serial number. If you really and truly are on welfare or family benefits, you have to prove that. You have to tell them how many people are in your family. The thing that you get is very inadequate. Recently, and I think I understand some of it, you cannot go to more than one food bank per month, because now they have you computerized, which is really fun. If you run out of food and your children are hungry, you can only be serviced by one food bank. Then that goes back to the basics.

I have two sons. I do not get an adequate amount to live on for the month. I am sorry, but I really do not. I have to scratch and really use my wits to get through the month and then I have to possibly use a food bank, or there is another scam going around. I get my cheque and there are Money Marts and places to cash my cheque ahead of time. So if I do not want to go through the indignity of going to the food bank with humility, I can get my cheque cashed, but it would take about $30 to $50 off my cheque which already the government has given me.

I think some dignity, respect and a raise so that I can exist and have the same self-respect as any of you going to a grocery store, being able to budget without having to go to the food bank -- I would like to see the food banks totally eradicated. The necessity is there for them right now. If you could see it clear to raise the assistance amount so that people can live -- food goes up, telephones go up. I do not know, even Bell telephone thinks it is a privilege to have a phone when you are on assistance. With my children, I feel it is a necessity.

Things that you people take for granted are things I have to struggle to obtain and struggle to keep, because the minute I am known to be on mother's allowance or welfare or anything like that there are a lot of things that are in jeopardy for it. Things that you can get on credit I must have the cash for, and sometimes it takes me a long time to get that cash. Then I may not make it because something may come up through the month, like my children want to participate in something.

I also want to speak to the education system in this province at the moment, or what I have experienced. My children go to school and because of the address they come from they are automatically seen as needing special education. The only thing they really need is the same amount of respect and consideration that your children would get in your school system. They do not need to be stigmatized or segregated or separated in any way. In any other class besides the poor class, a child is taken on his own merit and he rises or falls depending on his ability. When you see a child come from a poor section or from an address that you know is, say, Metro housing or Regent Park, you do not expect him to achieve, so you do not give him the opportunity, and unless he struggles really hard, he never gets the opportunity. I think that is wrong.

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When I was growing up in Toronto and going to school here, we had the "brighter children," the "average child" and the "slow learner." We all learned from each other, because everybody has something to give to a cause, to a community, whatever. I want you also to realize the way the children are quick learners. The way their parents are treated, the way they are treated, is going to have a profound effect on their future, on our future as a country. I think if a child grows up feeling cheated because of maybe the way he was treated through the education system or the lack of dignity and respect he was given because of the situation that his parent or parents found themselves in, that will come back on you some day.

I would like to see every child get the same advantages, to the best of everybody's ability, because to me my children are precious. I know your children are precious to you. They are something that is going to build this country and expand it. I want them to have the same opportunities, which may not deal with the issue of, you are thinking now, "What has that got to do with raising my level of income?" It has a great deal to do with it, because when my child goes to school, I want him to look just as good as your child. I want him to hold his head up high. I do not want him to be called a welfare case. I want him to feel self-respect. I want him to be treated the best as anybody can, as the next person.

In school, it starts when he starts to go to junior kindergarten. It is something I felt very strongly about. It is something I had to deal with with my older child. They sent him off to special education classes at the age of four. Then they come back and they reintegrate them, but they are always kept at a basic level. Another child can go to an average or the advanced. I do not think that is fair. I think if you are worried, maybe you feel that my child does not have the same advantages as your child, and it is true that he does not, but he certainly would like to have the same warm feeling going to bed at night, because he is not hungry; he would like to be able to have the same advantages of a warm coat, of things that are very basic things you do not even think about because you are able to provide them.

I would also like to talk to you about the working poor, the person who suffers, as well as the welfare recipient. The working poor man and his family struggle along and the working poor man starts to sometimes in his frustration think, "Why shouldn't I go on assistance?" He works and he ends up in the same address as myself. His kids go to school; he works. He sees nothing for his toil. He is heavily taxed. He cannot get himself ahead. His frustration and his anger turn on, say, the person on assistance, because he does not understand why that person is getting this and he is getting nothing.

I had a conversation with a friend of mine. I said, "Am I getting any more than you?" I am not. We sat down and we worked it out and he was getting far more than I and he still could not survive. He had double the amount of income and could not survive, and he worked for it. I work for it too. I am what you call a domestic engineer. I think my job is worthy of what I receive. In fact, it is worth a lot more than I receive.

I wanted to tell you about this. I wanted to tell you about the humiliation, which possibly you have never experienced, and I hope and I pray that you never do. But I also want you to realize that with the recession there are going to be thousands and thousands of people in this country put in the same situation. But for the grace of God, you could say, there go I. It is not a life that you would want to choose.

I hope that in your consideration and your deliberation you will consider the fact that I am really begging for the people who can hardly make it. I do not know what else to say to you. It is an urgent situation; it is a dire situation; it is a desperate situation. Every day there are more and more people being placed in this position. I have been around. Through the Ontario career action program and different things that I belong to, I have been down here. I have heard your promises, and I really want to see what you are going to do about what you said you would do, because I believed in you. Thank you.

Mr Kwinter: I just want to thank you for the presentation. It was very moving, and I certainly understand your plight. Again, I have a concern that some solutions are simplistic. I want to address the minimum wage in particular. There is no question that anybody earning minimum wage is certainly earning a very paltry income.

The problem that we have, and we have been hearing this throughout the hearings, is the problem of our competitiveness. Capital is fluid; it goes where it thinks it can get its best return. What happens is that when people are looking to invest, and we are a heavily investment-dependent jurisdiction, they look at all of these components. They look at our taxation, they look at all of the things that go on, and minimum wage is one of them.

We have had a policy, which changed just last year, whereby we have always been in tandem with Quebec, because we felt that the minimum wage in the United States was far below ours but at least we should keep in tandem with Quebec. This year we have deviated from that. Quebec maintained its minimum wage at $5; we went to $5.40. I have no quarrel with that.

The problem is that if we were to go to the goal of 60% of the average industrial wage, if you did it immediately, you would be at $7.20, and even if you did it in five years' time, with inflation built in, you are looking at a pretty substantial number. But that is not all of the problem. The problem you have is that those people who are at the minimum-wage level -- and as I say, my heart goes out to them, and I think they are entitled to more money -- but there is a sort of a reaction effect. The other people, people who are now earning $8 an hour for relatively menial tasks, their mindset is that they are out earning X dollars above the minimum wage, and when they sort of evaluate their income and their job, they say: "My God, I won't work for that; that is minimum wage. I am worth more than minimum wage. I want -- " whatever it is.

As I say, I know from personal experience because my family has a business and we hire a lot of unskilled people, and these are people who cannot even speak one word of English, but they know one thing when they walk in -- $8 is the starting fee. That is what they want.

When the minimum wage goes up, it would be great if the only thing that was affected were those people at the minimum wage, but what happens is, everybody other than the highly skilled workers who have got union contracts that pay them in the $20 range, whatever it is, but that other sector, which is very significant, will immediately react and say, "Well, if the minimum wage has gone to $6 or $6.50 or $7.50, then certainly the differential between that wage and our wages diminished dramatically and we of course want to go to $9, $10 or whatever it is." It has this escalating, ratcheting effect, which then impacts on our competitiveness. That is one of the problems.

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It would seem to me that what we have to do is address the problem of the people who are at that low end of the wage scale, but in such a way that it does not automatically ratchet the whole thing up, where what it does is raise the actual number but in the long term does not change anything, because all you are doing is playing with numbers but you are not playing with what happens. It just sends everything up a notch higher and you have the same relationships. You have the people who are at the bottom still being deprived.

That is a concern I have and I do not know the answer. I am just saying that I have wrestled with this for a long time and I believe that just changing that number is not necessarily the solution. If you could do it in isolation that would be great, but it cannot be done in isolation and it is going to have an impact all the way up the line.

The other thing I want to talk about -- again, I apologize because I have not been able to keep abreast of everything that has been going on in the Legislature for the last six years -- is that it seemed to me that we had discussed this problem you have about cashing welfare cheques. It may have been in private member's hour or whatever. I thought we had addressed it in the sense that we had made it illegal for someone to charge a premium over and above what he normally charges for cashing any kind of cheque and that we were going to provide some sort of photo ID that would not be a credit card, per se, but would certainly be tied to the welfare cheque so that you could go into any financial institution. It would have your picture, your signature and a correlation code, so that the cheque would go in and you would have no hassle as long as you could show the card to show that you were in fact the recipient of --

Mrs Sullivan: At the bank?

Ms Pringle: A welfare cheque is one of the hardest cheques to cash. The bank does not want to take it unless it is the exact date. But sometimes I run out of food before the exact date, so I have two choices: I can go to the food bank which gives me nothing, okay, or I can get my cheque cashed. In doing so, the amount of days ahead that I have to cash that cheque is the amount of money they take off that cheque, and it is a percentage.

Mr Kwinter: Let me just tell you another problem, and this was certainly addressed at the federal level. People who filed their income tax were entitled to a refund and went out and discounted it before they got their refund back. In other words, they would go to an institution that specialized in that and they said. "Bring us your income tax return and we will give you the money that you are going to get back from the government." What they did not say is, "We will give it to you, but we will take a very healthy percentage of that for our efforts."

What had happened was that the federal government, I think, has stepped in to prevent that from happening, but there is also an educational problem and I do not know how you would do it. They found that there are people out there -- it did not matter if it was two days away -- who would still go out and discount those cheques because they want the money now and are not going to wait two days. That is a problem. It is a problem if you are really in dire straits. There is no question about that.

To my mind, these are issues that can be addressed on the one side, the actual logistics of how you get the cheque cashed, how you do that. How you alleviate the desperation that sort of puts you in a position where you cannot wait that one day or that two days: I do not know how you can address that with that vehicle. Those are just the things I currently hear.

Mr Clarke: Actually, just quickly on the question of the cashing of cheques, in fact I was part of a deputation that met with you a number of years ago and discussed the very point. There were a number of initiatives that needed to be taken, many of them federal, but one of the key ones that could be taken by the province is the question of the postdating of cheques.

The problem you have is that assistance cheques are mailed out. They are dated for the first of the month and yet they usually arrive on the 27th or the 28th of the month. People then find themselves in a situation where they have a cheque they cannot cash, so they go to Money Mart or whatever, which takes its cut. Some municipalities, including I believe Metropolitan Toronto, have decided to date the cheques for the time when they actually arrive and they can thereby be cashed. That has substantially reduced the number of people having to go to Money Mart. I believe that in Hamilton-Wentworth they discovered about a 50% drop in their business. But some of the changes have to be tackled at the federal level through the Bank Act as well.

On the question of the minimum wage, we could, I suppose, wax philosophical. We are really into a situation where I suppose that what it comes down to for us is a basic bottom-line position that people have to be entitled to a living wave. To peg the minimum wage at a sub- poverty level is to us unconscionable.

I think working people throughout history have come up against the competitiveness argument. It cuts both ways of course. You can say that the minimum wage should go down and then there would be more employment. It seems to us that Ontario, as a wealthy province, should be taking a lead on the question of the minimum wage and pushing it up.

Frankly, this discussion on it between you and me is somewhat academic. What we are into is a situation where we are dealing with a concrete election promise. The government in power did subscribe to the view that the minimum wage should be raised to that figure. So I think, frankly, we are addressing our comments primarily to that side and saying that we would like to see very rapid movement.

Mr Kwinter: Good luck.

Mr Phillips: You kind of said it, John, the last time you and I had this debate in front of my campaign headquarters. I put forward the best argument I could of why we arrived at it. The rally was organized by the labour council and stuff. It was good publicity for the NDP, no question of it, and the NDP won and we lost. You got the promise.

I went through with you, John, as you remember, that I had concerns about the number of jobs that might be lost, but we lost that argument. I went through on the social assistance side and said, "Listen, we've doubled the budget from $3 billion to $6 billion over five years." The NDP has said that is not good enough. As you say, I think it is academic. You are addressing your comments to the right side and the best we lowly opposition can do is to hold them accountable for it and see just what happens.

It was an interesting debate on the front lawn, emotional and not particularly pleasant for me, because, as I say, there was lots of emotion involved in it. We were made to look like the bad guys. The best we can do for you, John, is to say, "They won, we lost and we will watch them."

Mr Stockwell: Frankly, you are going to find a lot of promises they made that they are going to have to fill. You are not the only one here who has come forward who has reminded them they made promises. They have already in fact broken some and there is going to be a string of them. I am quite sure. I am quite certain your promise is going to be another one. So it is going to be an interesting five years we have ahead of us.

I would like to see how they defend themselves too. It will be interesting hearing them tell you exactly what they plan to do, considering that they were very clear-cut and very understanding during the election as to what they could do. It has changed and that is what happens when there are elections and people get power.

Mr Phillips: Don't be cynical.

Mr Stockwell: I am cynical, aren't l?

The question I have is on the cycle we are in now with respect to the process and the amount of money and so on. How long has it been now since you have been caught in this cycle where you are spinning your wheels, basically, and you have lost your job?

Ms Pringle: Ten years. Ten years ago the situation was that my husband and I separated and I did not have the skills to go back to work, but I also feel that my children were my priority.

Mr Stockwell: I am not arguing that at all. I was just curious with respect to you having said you came into this problem because you lost your job through no fault of your own.

Ms Pringle: No. I said people find themselves in these situations through no fault of their own. I do not want to perpetuate the cycle. I want my son to grow up and look for a job and have some self-esteem and self-respect.

Mr Stockwell: I am not arguing that. That is not the question. I do not mean it to be the question. I do not want to be taken incorrectly. I thought you said that this happened through no fault of your own because you lost your job.

Ms Pringle: My husband and my job; they both left.

Mr B. Ward: She said through no fault of her own, but she did not say she lost her job through no fault of her own.

Mr Stockwell: I am sorry, I misinterpreted that. I see. So now it has been 10 years that you have been caught in this, and I assume through your statement that at some time during the process you moved into some form of Metro housing.

Ms Pringle: Yes, I did. I am very fortunate because I live in Metro housing and it is geared to income, but what cracks me up is that it is also government-oriented, so as soon as my minute increase comes, Metro housing grabs it.

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Mr Stockwell: They grab 33% or whatever of that minute increase?

Ms Pringle: That is right, so if my cheque goes up, my rent goes up.

Mr Stockwell: I understand that too. Today, though, as we see it, you are fortunate to be in Metro housing.

Ms Pringle: I am. There are people out there who are trying to exist --

Mr Stockwell: Who are not in Metro housing.

Ms Pringle: -- on these cheques who have to look for regular housing. They have my heartfelt sympathy, because there is nothing out there.

Mr Stockwell: Right. Now considering the fact that you are in Metro housing, which is, again, geared to income, I assume 33% or some type of figure like that of your income is paid as rent and the rest is left for you to spend however you can spend it.

Ms Pringle: It sounds so easy.

Mr Stockwell: I am not pretending for a moment to make it sound easy. I am just trying to get the rules down and those are in fact the rules, so you would be a more fortunate individual than the ones who do not get some form of assisted housing.

Ms Pringle: I am. However, I do not feel fortunate because we live in a country that is rich in grain and rich in food.

Mr Stockwell: "Fortunate" is maybe the wrong word. I will withdraw "fortunate."

Ms Pringle: I do not understand why I am in this position when I am in one of the richest countries in the world.

Mr Stockwell: That may well be true and I can understand your feelings.

The other question is, what about a job search? At this point in time you are staying at home to look after your children. Again, it is admirable, and I am not suggesting it should not be done that way, but my question stands, though. Is there any thought of maybe going out and looking for a job?

Ms Pringle: I have taken part-time jobs, part-time because on assistance you are not allowed to make anything.

Mr Stockwell: No, I understand that, but I am thinking more of a full-time job that pays you more than assistance.

Ms Pringle: If you do, they take your benefits away immediately and they do not allow you to get on your feet.

Mr Stockwell: Again, I do not want to put words in your mouth, but I am trying to get the questions asked and clarified. I am thinking more of a full-time job that would pay you more than assistance.

Ms Pringle: I would love to find it, but I also need --

Mr Stockwell: And you have not found it in 10 years?

Ms Pringle: I have not found it. I find part-time jobs around Christmastime to help me get through Christmas.

Mr Stockwell: Okay. The last question is if, for instance, a job were offered at full-time money that paid you more than assistance, would you be interested in going back to work?

Ms Pringle: I certainly would.

Mr Stockwell: You would be interested in going back to work.

Ms Pringle: Yes, I would. Have you got a job?

Mr Stockwell: I do hire some people, but I do not have a job right now. I have just laid off a bunch of people.

The last question I have is, have you in fact looked for that full-time job?

Ms Pringle: Yes, sir, I have.

Mr Stockwell: And you cannot find a job in 10 years?

Ms Pringle: No.

Mr Clarke: Perhaps I could just make a point. We talk of a cycle, but I think in the 1980s recession to recession, as it were, what we have seen is not so much a cycle as a descending spiral, in the sense that the recession we are now getting deeply into is fundamentally a different creature from the last one in the sense that throughout the period of the 1980s the welfare case loads did not come down significantly. Also, you had an enormous transfer of people over to the low-wage, primarily service, sector in terms of the employment that was out there.

As to the shape that poor people are in, they are already suffering more and in much greater numbers than previously. The impact of the recession, therefore, is proving to be that much greater. I think that is something that needs to be taken into account when emergency measures to deal with the situation are looked into.

Mr Stockwell: Again, we could wax philosophical, I suppose, about that stuff as well, all day, and probably it would not make a wit of difference because we do not happen to sit on that side of this committee.

The question, though, that I was driving at is, if there were available work, is it something that would happen?

Really the answer is yes and that is good. Sorry; go ahead.

Ms Pringle: Could I finish? I am sorry; I realize that I did not really, truly answer your question properly. If I were to go to work I would need supervision for my children and I would need bus fare. What I am saying to you is that there is no support system from A to B. If you sat down with me, you would tell me to stay on welfare because by the time I get all these things looked into and approved, like day care --

Mr Stockwell: Would you qualify for subsidized day care?

Ms Pringle: No, I would not. I have two children, so I would maybe be subsidized for one, but have to pay for the other.

Mr Stockwell: No. I mean, if you qualify, you qualify.

Mrs Sullivan: Mr Chairman, I am not sure that it is relevant to speak directly about the individual case of the person.

Mr Stockwell: I am sorry. Mr Chairman, I certainly did not want it, but the deputation was clearly an individual deputation and this issue was clearly brought forward. All I was curious about was this individual case. If we were not going to discuss this, that is fine, but you are going to have deputations about individual cases and I think we should have at least a little bit of leeway to discuss it.

The Chair: I think there has been a lot of leeway on this one already.

Mrs Sullivan: I think I reached my level of tolerance, I suppose, and that is why I raised it.

The Chair: I would like to move to Mr Hansen's questions now.

Mr Hansen: John and Heather, I am not here to criticize on your personal lives there like Mr Stockwell.

Mr Stockwell: On a point of order, Mr Chair: That was an unfair comment. It is out of order and it is totally unacceptable. I did not criticize their personal behaviour or personal play. I take great exception to that.

Mr Hansen: I take that back. I apologize.

The Chair: Can we move along?

Mr Hansen: In 1981-82 I was involved in a local church starting up a soup kitchen and I know the dignity that a lot of people lost at that particular time on the loss of jobs. I have experienced it first hand in that particular area. The one thing that did happen at that time, at that Christmas is that you are talking about having have to go in and give your name, where you live and what you collect on welfare. What we had was some people who were working at the local plants making $40,000 and $50,000 a year coming in and picking up toys, picking up food. It was some way to check that the people who were not entitled to it were not receiving it. So what happens? It comes down to the people who are supposed to be receiving it having to go through all these checks.

I am just trying to explain what I could see going on. I think what you are saying is that you have to go through all these checks in order to get there. It is because of the people who can afford it who are going in and collecting, and so that there is enough there for people who do need it. I think that is the reason there.

On the cashing the cheques, I know that has been a big problem, and explaining what you said, that staying home is better than actually going out to work in some instance with the system the way it is. I think it is going to take this government a little while to figure out how to work in all these plans coming up. We had the throne speech 20 November. We are just a couple of months in there, and as we have been told we are spinning our wheels right now, but I think it is going to take a little time. It is not going to happen tomorrow or next week. It is going to take a little while before everything comes into place.

With the economy the way it is, I realize that -- not only yourself; it has been there for a few years -- we are going to have a lot more people in the same situation and we are going to try to address it.

Mrs Sullivan: I have been very interested in following the recommendations over a period of time that have come out of the Ontario Coalition Against Poverty. I think that for the most part, no matter what government, there has been real attention paid to the words that we say and to the meaning and experiences that come behind those words. I look at your recommendations today. I think the major one, the rate issue and the minimum wage issue, have both been included in the Social Assistance Review Committee report. Initial steps have been taken to implement the SARC report and with luck and with good management, indeed those increased steps will be taken over the next period of time.

I was quite interested in your comments that you felt the province should take over 100% of the delivery of social assistance. Certainly that was the municipalities' position last year and, I guess, the previous year. I think it was also the position of the SARC report, although I was flipping through things to see what kinds of recommendations they had made in those areas. One of the things the SARC report pointed out is that no matter who the deliverer is, whether it is provincial or municipal, a major constraint is the cost of housing. Are you still seeing that? You did not raise it and I wanted you to have the opportunity to speak to it.

Mr Clarke: I think it is absolutely unquestionable that the cost of housing is a major question. We have supported initiatives that we see coming out of this government around rent control. We note the commitments made around areas of non-profit housing, etc, in An Agenda for People, the document submitted by the government when it campaigned for office.

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Unquestionably, those things are true and we would indeed want to go on record as continuing to support them. We would want to continue to support initiatives around child care, another absolutely vital question. It is simply that we want to zero in on something that we see as being a very simple, straightforward question, the question of income adequacy, as being perhaps an area where in the most clear-cut and obvious fashion a government that, quite frankly, we expect and hope something different from can act and act with dispatch. So if we are little myopic, it is, I think, deliberate.

Mr B. Ward: Just a quick question and comment. I think that what you are saying, John and Heather, is that until poverty is eradicated from this province, if it ever will be, you and your organization are not going to go away. You are going to keep our government on its toes so that we can progress from a socioeconomic standpoint for the betterment of working people who are at the poverty level. That is the basic message, that you would like to see some clear-cut action against poverty in this province.

Mr Clarke: Undeniably true.

The Chair: I have just a quick question for my own information. When a person collects welfare then goes on out and receives money from a job, at what rate is the welfare reduced?

Ms Pringle: I can collect $150 over and above my family benefits cheques.

Mr Kwinter: Over what period of time?

Ms Pringle: Per month. Then over and above that, I must pay back the welfare. If I make $200, I have to give $50 back because they consider they have already paid me.

The Chair: So it is dollar for dollar?

Ms Pringle: It is dollar for dollar.

The Chair: What impact would there be if that regulation was removed?

Ms Pringle: I think that would be great, if there was a support system. If anybody took the opportunity to find a job or go back to school and get training or whatever and went into the job, as long as there was a support system in place until the person got on his feet. For instance, it takes three months for OHIP to go into place. I think three months after you have paid your last payment, it supports you until you get another job or you go on assistance or whatever, so if there was a place there where it was supportive.

Imagine we were not in a recession, but people who are struggling to get back into the work force find that leaving the welfare system, and it is a deadly trap, trying to struggle to leave it, they have everything cut from beneath them before they are able to pay for things like drugs, which are phenomenal in price, or a dentist.

Even on assistance, unless my teeth are rotting in my head, I cannot go to a dentist, you understand, unless I want the teeth removed or a plate. My children can get fillings and things like that, but it is $45 to clean my teeth. My teeth rot in my head until I cannot take the pain any more and I go and get the dentist to remove them.

I wish you could appreciate that, because that happened to me only last year. The card says emergency benefits. My children can have their teeth cleaned -- thank God they can -- and everything looked after for them, but I must have my stiff upper lip and wait to the point that I must remove that tooth. It is beneficial in a way. I kind of laugh when you say family benefits. But then it is also a very slow punishment too. It depends on which part of the thing you see now.

The Chair: I thank you for coming. All I can say is that there will be long, hard debate on this issue over the next while. Thank you for your presentation.

PERSONS UNITED FOR SELF-HELP IN ONTARIO

The Chair: Our next presentation is Persons United for Self-Help in Ontario; Francine Arsenault, co-ordinator.

Ms McGregor: This brief is not just from Persons United for Self-Help in Ontario, which is PUSH Ontario, but also from Disabled People for Employment Equity.

Mr Southern: I want to say before we start that I am glad that the committee responded better to the last presentation than it did to the income maintenance committee's presentation. I was a bit disappointed in that. Not one question was asked of our committee. We worked damned hard on that presentation. I got the feeling that some of the committee members felt they had heard it all before. In fact, one of the observers who came in said that one committee member read the paper, and I will not say who, but I would appreciate it if you would give us your full co-operation this time.

Mr Sutherland: I will just tell you one of the reasons I did not have any questions was because you had it well documented in a written form.

Mr Southern: I do not think you have to justify yourself.

Mr Sutherland: No, I am just saying there was a sense that maybe some of the committee members were not as interested in that presentation or what have you.

Mr Southern: I think the last presentation was not that different from ours and people came up with enough for them. Disabled people are one of the biggest groups in Canada that are still living in poverty. Over 50% of disabled people in Canada earn less than $10,000 a year. I think that is criminal. We heard it said how rich this country is. Everybody seems to think that inflation and profit margins that employers are allowed to earn were caused by poor people. It was not and it is not. I get infuriated when I see how so-called politicians respond to some of these presentations. Sorry about that emotional outburst, but it does me good now and again.

Anyway, down to business. My colleagues are Richard Dector from PUSH Ontario, who is our project co-ordinator and helps keep PUSH afloat, and Carol McGregor, who, as the co-ordinator for Disabled People for Employment Equity for about a year, has done phenomenal work in the area of employment equity. I believe that this government's policy on employment equity, which we hope will come to fruition soon, was partially formulated by her hard work.

Anyway, what Carol is going to do is go through our paper. We are going to present a sort of joint DPEE/PUSH view on the various issues. I think Carol is going to read in point form, and I am going to comment on some of the stuff. Carol or Richard will also make their comments.

Ms McGregor: Thank you very much, Mr Chairman. I wonder if you would have the members do John and me the courtesy of introducing themselves. We do not have the ability to see their signs.

The Chair: I will begin. I am Jim Wiseman, Chairman of the committee.

Mr Christopherson: I am Dave Christopherson from Hamilton Centre.

Mr Sutherland: Kimble Sutherland from Oxford.

Mr B. Ward: Brad Ward from Brantford.

Mrs Sullivan: Barbara Sullivan, Halton Centre.

Mr Phillips: Gerry Phillips from Scarborough-Agincourt.

Ms McGregor: We lost some in the process, I think.

Mr Southern: Teatime.

Ms McGregor: Yes.

Mr Southern: Okay, Carol, let's go now.

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Ms McGregor: PUSH Ontario seeks to provide a unified voice for more than 900,000 Ontarians with disabilities of all kinds. Disabled People for Employment Equity is a coalition of more than 30 consumer groups and service providing agencies dedicated to ending the chronic unemployment and marginalization of people with disabilities. Together we ask the members of the committee to consider the following measures strongly.

Disabled people continue to live in unnecessary and unacceptable poverty in Ontario. We recommend the committee endorse the following steps towards changing this little-regarded reality.

Income maintenance, health and social services: We recommend that the government of Ontario extend the assistive devices program to include all equipment categories, including communication aids for the visually impaired.

Mr Southern: Keep going, because I spoke quite liberally on that before.

Ms McGregor: Disabled persons receiving government assistance who live with members of their family should not be penalized by being paid a lower "non-profit boarding rate." End this practice.

Mr Southern: I think it is worth pointing out, which I did not when we were making our brief before, that if you live with family, you get what is known as a boarder's rate, which is less than the rate if you live on your own. Obviously it is just crazy and stupid. Certainly when you hear of provinces talking about encouraging families and whatever, I do not think it does much for that.

Ms McGregor: At a minimum, implement indexation of social assistance rates to the consumer price index to ensure that rates reflect more accurately the true cost of living.

Mr Southern: That is self-explanatory.

Ms McGregor: In many families, a non-disabled spouse acts as both a care giver and a wage earner. A rate increase to lessen strain on these families should be considered, if only because of the enormous costs spared the health care and social service system by the unpaid efforts of such couples. Maintaining benefits at unlivable levels is not only immoral, it is bad economics.

Mr Dector: I would like to add something here. One of the issues that was considered at great length by the previous government and is no doubt going to be looked at again by this government is long-term-care reform. One of the elements of that reform is whether or not things like respite will be given to people who are in the position of taking care of, say, a spouse with Alzheimer's or situations like that. People who are in that situation are saving the government enormous amounts of money that would be spent on institutional care for people, and that is part of what we are talking about here, measures that in the short run bring some cost but in the long run save a great deal of money.

Ms McGregor: Make accessibility a priority in the provision of affordable housing. PUSH welcomes the shelter subsidy increases accorded under the FBA. However, the supply of affordable accessible accommodation is inadequate throughout the province. "Inadequate" is probably an inadequate word.

Mr Southern: Yes, it is a major problem for disabled people. Only a small number of persons with disabilities are as fortunate, or whatever word you want to use, to live in publicly supported housing. For example, I myself live in a co-op. I can just about afford to live in one of those.

Mr Phillips: You can go to my riding, John.

Mr Southern: I wish I could.

Ms McGregor: Improve the supports to employment program. We welcome the improvements already made to social assistance under STEP, but recipients must be allowed to keep a greater percentage of the income that they earn. Any comments?

Mr Southern: The STEP program could be a big advantage to a lot of people on social assistance but, in my opinion, it is certainly not a great help to disabled people. There are so many costs involved, as I pointed out earlier, with disabled people leaving social assistance. For example, just this month I left social assistance, and everyone might be saying, "Oh, that's good," but I am losing money. I am earning less money now than I was on the STEP program, but I am earning too much to be eligible for it.

Next month, as was pointed out the problem with the dental program, I have got to go to the dentist. I have got no dental card left any more. It is going to cost me $100 and I will really be out of pocket. I think that the benefits and the levels of the STEP program have certainly got to be raised a lot more, but it is a step in the right direction, no pun intended.

Mr Dector: I would like to add something, another practical example: An employer wanting to offer someone who uses an electric wheelchair a job -- I gather everyone here is in favour of encouraging that sort of thing -- is in a position where, say, the wheelchair requires repairs on a regular basis. This is a very common situation. If the person is paid over a certain amount, he will lose all eligibility for FBA, say, $10 an hour for a single person on disability. If they are paid $8.50 an hour, they can retain their FBA drug card and also continue to have the repairs paid on their wheelchair.

An employer is put in the position, and I am speaking from some experience, even with all the assistance in the world from lawyers who have studied the social assistance system, of having to guess at what point he will be knocking somebody off and that person will be actually in a worse situation than if he did not work at all. In our membership, we are talking about people who have been looking for a job for 10 and sometimes 20 years. It is intolerable.

Mr Southern: I will ask Carol if she could skip some of the other social assistance areas. Many people have presented on it and perhaps we could get to some of the other highlights like transportation.

Ms McGregor: I am going to turn the transportation over to Richard and let him proceed.

Mr Dector: PUSH is active in a group called TransAction. It is a coalition of groups concerned with accessible transportation. This is PUSH's position on some of those issues.

We want the new provincial government to fully commit to a fully accessible public transportation system, just as the preceding government did, and we are very hopeful that is going to come.

We need to see adequate funding to ensure the projects outlined in the Minister of Transportation's November speech will be fully accessible to all Ontarians. That includes a fully accessible GO Transit system. Via Rail has been cut back considerably, as everyone knows. Via Rail, bad as it is and was in certain respects, was the most accessible transportation system in Canada.

In that regard, GO has to be improved, otherwise people are stuck in a situation where there is decreasing accessibility on the airlines because of deregulation, the intercity bus services are not accessible and the trains are being cut back, and what you are essentially saying is, "If you can't drive, you have to stay at home."

Mr Southern: I just wanted to make a point on transportation. I heard of somebody just recently who was offered a job and could not take the job because he could not get any reliable transportation.

Mr Dector: Yes, it is crazy. I was talking in quite practical terms, people being offered a job and telling the employer that they can start four days after the starting date because they need some time to arrange their WheelTrans. That does put you at somewhat of an employment disadvantage when you cannot take a job even when you are offered one.

The other thing is that the bus situation is so bad that I have had members say that they are going to use the bus service to come to a meeting, but it means they have to crawl up the stairs. It is unbelievable.

We want to see that the Let's Move projects in Metro, such as Spadina light rail transit and Sheppard, are fully accessible. Everyone has talked about making Sheppard fully accessible. We want to see that a reality. We want funding, as the minister has indicated, to ensure that the recommendations in the TTC Choices for the Future report are paid for. We need increased support for parallel services.

Again, we are asking for more and more money for different things, but parallel services means things like the Peel regional cutbacks. In that case, people are at risk of losing their jobs or health care or education, because they cannot get there. There is some long-term cost for short-term gain.

Mr Southern: It is ridiculous. In the Peel region, for example, they are going to cut back on the parallel transit system and disabled people are expected to say, "I understand that you can't afford it." Damn it, if people cut back and slashed the TTC system by 50%, you would have heard a little bit more than, "Oh, well, they understand its cost," I tell you.

Mr Dector: Imagine if you had to book four days in advance to go in the subway, which is the current thing for the Wheel-Trans.

To establish and improve accessible public transport in rural areas: One of the lower cost alternatives here is community bus services. That is something that has been talked about. There is one pilot project in Metro. These are smaller buses on flexible schedules. They are buses that virtually anyone can use. They are either low-floor or they have ramps, you can go on with a stroller, you can go on if you are a senior citizen who uses a walker, and they are wheelchair accessible in some cases.

We are fully in support of those and we would like to see funding for that. We also would like to see funding for proper training of transit staff so they are aware of how to deal with people with certain types of disabilities, because there is some getting used to people. That is it for transportation.

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Ms McGregor: I would really like to really reinforce the transportation. I am one of these who happen to live in Peel. I ride the GO train every day and I cannot get home at night; I often have late-night meetings because people who are in this employment equity area are working in the day. I am trying to get home at 10 or 11 o'clock at night, and I am always having to take taxis from Clarkson up to Meadowvale, which is at Winston Churchill Boulevard and Highway 401, because we do not have commuter transit service up there yet. Not that it is accessible, but at least I have the dog and we can get up and down. But it is not the safest place to try to get around at night.

Our students up there are in great peril. I am going to talk about education because I have had quite a few phone calls from disabled students. Their education is in jeopardy, their future employment is in jeopardy, basically because of the transportation. They are also faced with costs substantially higher than those facing able-bodied students in the education area.

OSAP was introduced. It replaced vocational rehabilitation services funding of tuition. Students must apply for OSAP funding for tuition. They are also required, at the same time, to save out of their $600-a-month pensions $1,200 a year -- a lot of people with disabilities are finding this very, very stringent -- in order to match the donations by kind. There is no difference made between disabled students or able-bodied to go to university or college. You are treated the same. We want to be treated the same, but recognizing the fact that a person with a disability has a much higher cost of living. Our medical costs are higher, our transportation costs are higher, medications and just general living. It is much more expensive for us to even access.

By jeopardizing our services at university and college, we are creating great barriers to employment. As a person who is advocating for employment equity, I view this very seriously. I have students phoning and saying: "I think I'm going to have a nervous breakdown. I can't get my books. I'm not getting my educational materials on tape on time. The professors won't give me extensions." The accommodations are not there. The funding is going to the colleges and the universities, but our students are not getting the accommodations they need. They are just saying, "Will you keep fighting for us?" Yes, we will keep fighting, because equity in education has to be a prelude to employment equity.

We do feel, though, that the transportation cost in particular should perhaps be seen as an accommodation under the funding that is supplied to the colleges and universities for special-needs students. In the federal public service, the Human Resources Secretariat right now is treating transportation as an accommodation, and I do not see why our students could not have the same courtesy extended.

Employment equity: Obviously, for disabled people we feel this is a very crucial matter. Nationally, more than 171,000 persons with disabilities capable and available for work are unemployed. The cost of maintaining this number of people is more than $2.2 billion per year. If these 171,000 this is based on the 1986 census; we will not know what the new census is until 1991-92 -- were employed at an average salary of $20,000 per year, which is not very much, their contribution to the economy would be more than $3.4 billion per year. Therefore. putting this enormous population of people who are more than willing to work into the active workforce would lift $2.2 billion from government costs and add $3.4 billion to the pre-exemption tax pool.

Ontario would be the single largest beneficiary of this tremendous boost to the economy. Therefore, Disabled People for Employment Equity and Persons United for Self-Help in Ontario recommend immediate introduction of mandatory employment equity legislation covering both the private and the public sectors. This was a commitment promised to us by the Liberal government at the NDP-Liberal coalition, and we are still waiting for this legislation.

Mr Southern: Every time I made a presentation in the past to this committee, one of the people on the committee at the time was Bob Mackenzie, and he always used to ask me about quotas and employment equity or whatever you want to call it. He always used to say how much he supported our call for it. Now he is the Minister of Labour, so let's see it.

Ms McGregor: We believe there should be more mainstream training and educational opportunities for persons with disabilities in the workplace and at community colleges and universities. We want to de-emphasize segregated training programs. Training remains the single most important issue for disabled people.

Persons with disabilities, just by the very nature of their disabilities. sometimes miss a great deal of time at school. They are not offered the same employment opportunities in the summer as their able-bodied counterparts. Society has not seemed quite willing yet to hire a disabled student in a fast food place, for example. They come to the job force unequipped with the skills that are necessary. We must provide that training that we feel is necessary. We have a generation out here that we have lost. We cannot afford to lose another generation of people who are disabled.

A special fund, we believe, should be set up to enable the provincial Human Resources Secretariat to identify systemic barriers to employment within the public service. The civil service accommodation fund that is administered by the provincial Human Resources Secretariat must be continued on a permanent basis to permit people with disabilities equal access to employment in the Ontario public service. The personal staff of the ministers' and MPPs' offices should also be covered by this program.

During the recent hiring, disabled people were very discouraged. We managed to get two people in. Both those people required accommodation. Both those people have had extreme difficulty getting accommodation. We feel that something must be addressed. We have good people, well qualified, out here for you, quite able to work. We do require accommodation, we require equipment and perhaps some other needs. I think this affects their job performance when they cannot access this equipment, so we strongly urge you to consider this.

The provincial government must establish an additional accommodation fund for employers to whom accommodation would represent undue hardship as defined by the Human Rights Commission.

The province must provide extended health benefits, 100% maintenance cost for assistive devices and other equipment for persons with disabilities going from FBA to the workplace. This is a very cost-related thing.

I will let Richard close.

Mr Dector: This is going to sound terribly like a plug for funding ourselves, which it partly is. To enable disabled people to speak on their own behalf, significant and sustained funding must be provided to advocacy and self-help groups. I am not just speaking of PUSH, I am speaking of People First, which represents people with developmental disabilities, Ontario Association of the Deaf, the Disabled Women's Network, which barely has any staff, and of course our organizations.

A lot of people with disabilities who have been unemployed for a long time get involved in these groups as activists because they are concerned about a particular issue. They become volunteers, they represent us at panels, and they often get their first job through us and then move on. Some of them are even working in the government now. The point is that it is a route for people. Not only are we trying to fulfil an advocacy function, but it is a route to employment and off FBA for a lot of people. A large number of our staff have come directly off FBA.

Ms McGregor: I must point out to you that funding for advocacy groups is not easy to come through foundations. Because we are very political, a lot of foundations do not wish to be identified with some of the issues. When you take banks and put human rights complaints against them, and when you take the Minister of Employment and Immigration to court, foundations do not want to be seen standing side by side with you. The work we do is important. The issues we raise are important. They would not be raised if we were not here doing this. This is the type of work that disabled people are doing, so we urge you to consider it.

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Mr Southern: I have a little story just before we close altogether. At the last presentation to the committee I raised an issue that was in the newspaper, and when I got out of the meeting, an NDP researcher said, "Wow, we thought it was great in the NDP caucus office. We saw you on TV. It was fantastic." The issue was that MPPs from out of town get a living allowance for an apartment in town, whatever it is, $1,000 a month or something like that. That is just a living allowance for an apartment. The average rate of somebody on family benefits is $720. The story is still the same and that analogy can still be used. I do not know if everybody in the NDP caucus office will be jumping around still, but anyway, there you go.

Mr Dector: One other thing I would like to point out is that the kind of funding that is often given to groups like ours is project funding. Everyone is happy if we are working on certain types of issues and not so happy if we are working on others.

In fairness, no matter who the government is, I think there should be some core funding to groups like this so that the agenda can be set by the membership. We have a democratic structure; most of the groups do. Let the members set what we are going to work on. Last year, the biggest concern directly from the grass roots was transportation. This year, transportation is a big concern but people are really concerned about getting jobs. Maybe they are more optimistic or something, but there does seem to be a big push for that. I would like to see more freedom given to the groups to try to work on what people identify to us.

Thank you for your attention.

Mr Phillips: First, I think your groups have advanced the cause in the last 10 years enormously. You do provide real benefit to the community. Just as one politician who has been lobbied by you, you are probably aware you have made a big impact; not as much as you would like but you have made an impact.

I have three questions. One is in the area of transportation. Assuming that there are finite dollars, what is your first priority, do you think, province-wide? We tend to get myopic, those of us from Metro Toronto, and look at Metro Toronto, but I have this intuition that there are some communities where there is not even an adequate parallel service. That is my first question, if we can look at it province-wide.

The second thing is on the accommodation fund. I realize it is carefully worded in your document to say "where it is undue hardship." My own concern, when I was involved in it and had some responsibility, was that that has to be carefully managed or employers, when the fund is gone, can say, "Well, I can't hire someone because I can't get the support." I always had questions about the fund in the private sector, because it felt it may be a limitation. I would like your comment on that. I realize it is carefully worded. I can see the accommodation fund in the public sector because we are the employer, but in the private sector, as I say, I worry that it becomes a limitation.

The third one is on the STEP program. Is the issue there that the STEP program is in concept the right thing, but for persons with disabilities it is not properly structured to take into account the real costs that are associated with employment, and therefore one should be looking at the details of the STEP program as it applies to persons with disabilities?

Mr Southern: The first one on transportation: I do not like to be pulled into a "let's prioritize this list" thing. At first glance, you might say, "There's no transportation in Rainy River," but we need to deal with both rural and city issues. If you make, for example, the system in Toronto more accessible, the TTC, it can save you a lot of money which could be better spent in other areas. I think the answer is that you have to do both. That would be a proper way to spend the funds. I do not think you can just say, "Let's establish transportation in an area where there is none," and just leave the public transportation in the major cities inaccessible. Both have to happen, and I think if you do both you will save yourself some dollars.

Mr Dector: I agree with John. It is very difficult to prioritize, even if we had some of the people here who have been working on transportation issues. One point to make, though, is that, again, as in buildings and in other situations of accommodation, if the idea of accommodation is in the beginning of the planning process, the costs are minimal. We are talking -- the studies in the States -- 1% to 2% additional cost to buildings.

Sheppard is a clear case where it should be accessible from the start. One of the mistakes made, I think, is the presumption that escalators are cheaper than elevators, which is not always true and is quite often not true. If you look at the design of the subway system, if we had elevators a lot more people would be able to use it. The increase in costs of continually providing parallel services -- and we support increased funding to parallel services -- partly is that the mainstream system is not accessible. It is achievable. There are low-floor streetcars. There are buses in use in England and in other places on which you can take a wheelchair that are in use on conventional routes. There are ways to do these things without massive increases in costs if there is a real commitment to accessibility. That is what we are hoping for from the government.

Ms McGregor: Disabled people are having their transportation cut back. In Toronto Mr Tonks came out and announced that disabled people had to get used to less. They are already getting less.

Mr Southern: They just have to get used to it.

Ms McGregor: They have to get more used to getting less, or something like this. We have members who could not even get to minister's receptions.

Mr Dector: We had a member who could not come today.

Mr Southern: That is right.

Ms McGregor: The co-chair of our organization was unable to make three different receptions in the fall under the new government. We simply cannot get her there. We got her to the community action awards, but we could not get her home. That is wonderful. How are we going to get her home when she is almost a quadriplegic?

Transportation is a very big thing. I am going to talk about the accommodation fund a little with you. The community has been looking at the costs of accommodation, trying to really look at how business is going to react to that cost. We do not feel it should just be given carte blanche to companies who certainly can afford to pay that cost. We believe that when there is a separate independent commission, that commission will examine whether that employer is committed to employment equity, whether the representation rates of a community are there, and perhaps even some tax incentives.

Everyone has this great big myth that it is going to cost an arm and a leg to hire a disabled person. In many cases, it may not. Most of the buildings have become more accessible. It may be a matter of just lifting up a desk and putting it on a couple of blocks for a wheelchair person. But we are getting discriminated against based on disability, and we are getting very concerned, the way employment is going. We have employers saying, now that they have hired a few guys in a chair: "That's great. We'll take the guys in the wheelchairs, the paraplegics, because they look good. But don't give me the blind guys, don't give me the deaf people, because we've got to get interpreters. Certainly not the cerebral palsied, because look how they look. They can't talk properly, even though their brain works."

We are facing this discrimination. We wanted something that perhaps might encourage the employers and business to hire persons with disabilities. The accommodation fund is something we are working on. We certainly have not come up with all the details. We have enough time fighting with business, never mind trying to work with them right now. We are not the best of friends.

In the long term, we feel confident that probably with the federal review there may be some changes in the federal act, and hopefully in the province we are going to get the provincial legislation. It is going to have a bearing on the economy. It is up to members of the government, as well as the community, to examine ways to make this accommodation issue a little bit less frightening to everyone and certainly more accessible for the community to have access to. We will not back down on certain fighting for their jobs. John, do you want to answer on the STEP?

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Mr Southern: Yes. Somebody asked of another presentation what you were allowed to retain under welfare. On family benefits under the STEP program you can retain $160, the full dollar amount. Then after that it is 20% of every dollar earned up to a certain level, and then you are cut off, all depending on your circumstances and costs and whatever. The cutoff level changes. That is one reason why obviously it is difficult for disabled people. The levels should be higher because their costs are higher.

One recommendation that was in the income maintenance group brief which would certainly improve the STEP program for disabled people -- single mothers under the STEP program are allowed to put the costs of day care against their earnings and it would help if disabled people were allowed to put some of the extra costs. I know, for example, a lot of people who use crutches to get around. They have a lot of wear and tear on clothing and stuff like that. If they could put some of those costs against their earnings, it would really give the STEP program some meaning for disabled people.

Mr Dector: Yes, I would like to second that. In the example that I was giving, the issue there I think was whether or not the program could be modified in such a way that you could keep your benefits for equipment you need to function while you are working. That was the point at which this person's wage could go up, or whether he would make the transition to work.

Maybe one last thing: If you are looking for money to pay for all this, a couple of things --

Mr Phillips: This is a first.

Mr Dector: One is, we are fully against any user fees on the drug card, but part of the enormous costs of the drug card is the fact that there is massive overprescription of tranquilizers to people with disabilities. This is a regular complaint from our members. If there is a way to look at that, and there are going to be some studies released on that soon, that is a real issue. Part of that is cosmetic. Someone who has cerebral palsy, who without a heavy tranquilizer dose will be perfectly functional but will drool a bit, is encouraged to take as many tranquilizers as it takes to stop the drooling. but it renders them somewhat dopey all the time. It is a cosmetic issue and there is real, genuine overprescription.

Another thing I would like to point out -- and I do not mean to pick a quarrel with the doctors, as my brother is a doctor and so is my father -- the total $2.2 billion that is required to sustain those 171,000 people is about half of the billing to the Ontario health care system by doctors last year. So there is probably some room there to find some of this money. I guess what we are saying is that it is a question of spending priorities rather than a question of whether there is money there.

Mr B. Ward: Just a quick question on the assistive devices program: How do you find the bureaucracy that deals with that program?

Mr Dector: Do you want to deal with that, John?

Mr Southern: The bureaucracy with the assistive devices program is not the worst thing. I think the problem with it is that there is not enough money in the program to provide people with what they need. That is the major problem. Of course, there are still some items that are available to people up to the age of 24. After that, you are not eligible for the program. There is still that age limit on some components of the program, which we would obviously like to see eradicated. But then I just do not understand why they do not put more money into the assistive devices program, because I think the benefits of the program could be enormous if they would put enough money in it to allow people to become independent and to acquire employment and live full lives; the benefits to society even cost-wise, never mind as regards social-wise.

Mr Christopherson: Thanks to the presenters for a most meaningful presentation. I have a quick question on the transportation issue of accessibility and the parallel system, and perhaps some comments on exactly what the vision of PUSH is on what the system would look like when it is finished.

If the main systems are fully accessible, then is it a fully parallel system that is required in addition, or are there special needs there? I know when I was down in Atlanta, Georgia, about a year and a half ago there was a major demonstration down there that hit most of the North American newspapers in fact, where there were sit-ins, I believe, about the whole question of accessibility.

There seemed to be an entirely different approach down there than what I saw in Canada. Then I attended a conference here in Canada and Beryl Potter had some difficulty or some differences of opinion with certain groups right here in Metro on the approach. I do not pretend to be an expert in fully understanding all of that, although my background is city and regional council, where you deal hands on with the transportation issue. I would appreciate if you could just clarify a little bit for me how you see all of that coming together.

Mr Southern: As I pointed out earlier, I think the two systems are definitely necessary. There are people who will always need door-to-door transportation. I think both systems could support each other. I know there are wheelchair users who cannot get all the way to the subway system or to the buses on their own because they live maybe 10 minutes or five minutes from the main intersection who would need some kind of transportation to get them at least there and then they could switch to the regular system, which would take an awful lot of burden off parallel systems.

In the best of all possible worlds, I think we need both. That is what we are lobbying for. There are people who really need different kinds of transportation. Also, I think what we need is not just vehicles that are capable of carrying wheelchairs, and it is not just vans, but we are lobbying also for some accessible taxis in Ontario. If they want to just decide to go out and have dinner. people should be able to get a cab and go out and have dinner. They should not have to, as Richard pointed out, book four days in advance. Do you know what you want to do next Saturday? I do not.

It is a very broad issue, transportation. You need a lot of things. I do think we need both systems and we do need the accessible cab system as well.

Ms McGregor: I think the demonstrations you are referring to in the United States were related to the Americans with Disabilities Act. The veterans who had been disabled from the Vietnam war, together with the disabled population, lobbied very hard to get this bill through.

There is a different attitude now in the United States on disability. There is no question of it. I was in the United States just to Florida in October. I did not feel disabled there. My dog and I were granted access. It was quite a change for me for taxicabs. I have to go to court again in March. I came back after having a lovely week just to sort of recoup myself. The first day back it was pouring rain and I am with Mr Scott from the city at a meeting, and he could not get a cab for me. He argued with this guy for 15 minutes as to why he would not take me. I thought: "That's nice. Let someone else do it for a change."

Mr Phillips: That is just unbelievable.

Mr Southern: Sometimes if we are in a hurry to get somewhere, we say to Carol, "Hide your dog while we get a cab" and then pull the dog out. We have to do that.

Ms McGregor: But I have to go home every night. I am at these GO stations and we are getting quite a rash of violent crime out there. When I cannot get people to pick me up, I get very upset. I get read as to why dogs -- you know, "God is going to come down and kill all the dogs." So I have to pay $20 and listen to that for another half an hour. But if we complain about services, you must realize that very often we are denied the services even more, and I expect I will be in March. I probably will.

Mr Phillips: You should just be relentless on that one.

Ms McGregor: I refuse to. I am going after them.

Mr Dector: If you bring them to the Metro licensing commission, there is a roadblock that Metro Toronto does not have an accessible taxi service. They exist in some of the smaller communities. We are in favour of taxis that can be used both by disabled people and by able-bodied people. There is no reason. That is partly a funding question, but it is largely a regulatory question.

Again with the buses, there are intercity buses that you can take a wheelchair on. I believe that the problem has to do with the length of the buses. There probably is some funding subsidy required, but again it is largely a regulatory issue.

There are a lot of things that can be done to change these things. These are not insurmountable obstacles.

The Chair: I would like to thank you for coming and making your submission. This committee will reconvene at 10 o'clock Monday morning.

The committee adjourned at 1810.